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KMID : 0352119920080030235
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Journal of Kyung Hee University
1992 Volume.8 No. 3 p.235 ~ p.244
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The Clinical Study for Cardiovascular Responses and Awareness during Fentanyl-N2O-O2 Anesthesia for Open Heart Surgery
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Abstract
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High dose fentanyl-O2 anesthesia is recognized as one of the anesthetic techniques for patients undergoing cardiac surgery because of its minimal cardiovascular effects and favorable amnesic effects. But, some anesthesiologists reported
intraoperative
awareness and excessive cardiovascular responses to surgical stimulation during high dose fentanyl anesthesia for cardiac surgery. They suggested necessity of a supplementary anesthetic agent to prevent the intraoperative awareness and maintain
hemodynamic stability during surgical procedures.
Some kinds of supplementary drugs have been used in combination with fentanyl in an effort to reduce the incidence of awareness, to control the excessive cardiovascular responses, and to attenuate the extent of postoperative respiratory
depression.
One
of the supplementary drugs, N2O has little cardiovascular effects by itself, but has been known to cause significant depression of arterial blood pressure and cardiac output when administered with fentanyl.
In a study conducted at Kyung Hee University Hospital, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP) at induction, tracheal intubation, skin incision,
sternotomy, and postcardiopulmonary bypass (CPB) time were recorded in order to evaluate the effects of N2O on the cardiovascular responses to surgical stimulation. We observed the occurrence of the intraoperative awareness, under fentanyl-N2O-O2
anesthesia of 16 patients undergoing open heart surgery. We compared this data with our previous study, fentanyl-O2 anesthesia and fentanyldiazepam-O2 anesthesia. Anesthesia was rapidly induced with fentanyl 12 mcg/kg+thiopental sodium 2 mg/kg
and
maintained with continuous infusion of fentanyl (1.5 mcg/kg/min prior to sternotomy and less than 0.3 mcg/kg/min until the end of surgery) and administration of 50% N2O continuously until just before the CPB and intermittently after CPB. The
patients
required a total dose of 83.3±11.8 mcg/kg fentanyl for the entire operation.
These measurements were compared with control values (before induction).
@ES The results were as follows.
@EN 1) During the induction period (infusion of fentanyl 12 mcg/kg with thiopental sodium 2 mg/kg); HR decreased compared with control value, but was not statistically significant. SBP decreased from 130±26.4 mmHg to 102±19.7 mmHg, DBP
decreased
from
78±10.5 mmHg to 65±8.6 mmHg, MAP decreased from 98±13.6 mmHg to 83±11.5 mmHg, and RPP decreased from 13066±4377 torr×beats/min to 9698±2784 torr×beats/min (p<0.05).
2) After tracheal intubation and during skin incision; SBP, DBP, MAP, HR and RPP decreased compared with control value, but were not statistically significant (p>0.05).
3) During sternotomy; SBP, DBP, MAP, HR and RPP increased compared with control value, but were not statistically significant (p>0.05).
4) After CPB; HR decreased compared with control value, but was not statistically significant. SBP decreased from 130±26.4 mmHg to 104±18.9 mmHg, DBP decreased from 78±10.5 mmHg to 67±10.3 mmHg, MAP decreased from 98±13.6 mmHg to 80±10.9
mmHg,
and RPP decreased from 13066±4377 torr×beats/min to 9680±2618 torr×beats/min (p<0.05).
5) Of the patients in this study, there was no recall or awareness of intrapoperative events.
6) Postoperatively, duration of controlled or assisted ventilatory support was 209±54 min.
These results suggest that fentanyl-N2O-O2 anesthesia might be more useful than fentanyl-O2 anesthesia for prevention of intraoperative awareness and attenuation of excessive cardiovascular responses during open heart surgery. But, after CPB,
fentanyl-N2O-O2 anesthesia repressed the cardiovascular responses more significantly than fentanyl-diazepam-O2 anesthesia. Therefore, continuous and careful monitoring for hemodynamic changes in patients will be imperative throughout the entire
operative procedure under fentanyl-N2O-O2 anesthesia for open heart surgery.
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