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Anesth Analg 1986; 65:46-52
© 1986 International Anesthesia Research Society
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Myocardial Metabolism and Hemodynamic Responses with Fentanyl-Enflurane Anesthesia for Coronary Arterial Surgery

Emerson A. Moffitt, MD, Allan J. McIntyre, MD, Richard A. Barker, MB, David D. Imrie, MB, David A. Murphy, MB, Rodney W. Landymore, MD, and C. Edwin Kinley, MD

Received from the Department of Anaesthesia and Division of Cardiovascular Surgery, Dalhousie University and the Maritime Heart Centre, Victoria General Hospital, Halifax, Nova Scotia, Canada.

Abstract

Ten patients for coronary vein grafting had induction of anesthesia with fentanyl (30 µg/kg), followed by enflurane-oxygen sufficient to decrease systolic blood pressure by 27% before intubation. Enflurane was continued in concentrations to maintain blood pressure below that with patients awake. All patients had preserved ventricular function and effective ß-blockade. Studies of hemodynamic functions and myocardial blood flow and oxygenation were done before induction, six times during anesthesia, and twice postoperatively. The blood pressure decrease on induction and before bypass was due to reduced cardiac index without decreased heart rate or systemic resistance. Stroke work index decreased 47% on induction and remained below awake level throughout. Coronary sinus blood flow decreased 26% after intubation and remained so before bypass. Without change in coronary resistance, coronary sinus oxygen content increased 30% on induction and stayed elevated before bypass. Normal lactate extraction continued after induction and increased before bypass; mean extraction decreased after bypass, with one or two hearts producing lactate in the first 24 postoperative hr. Fentanyl-enflurane-oxygen maintained a steady mild hemodynamic depression during the operation and soon afterward, which preserved myocardial oxygenation.

Key Words: ANESTHETICS, VOLATILE—enflurane • ANESTHETICS, INTRAVENOUS—fentanyl • SURGERY, CARDIOVASCULAR




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.