Recently, nalbuphine has been used for reversal of opioid induced respiratory depression Because of its structural character, nalbuphine has been known as a better narcotic antagonist with keeping analgesic potency and without considerable
cardiovascular responses. Some investigators reported nalbuphine can decrease minimum alveolar concentration(MAC)of major inhalation anesthetic agents and can be a intravenous anesthetic adjuvant but can accompany several adverse reactions such
as
hypertension and tachycardia etc.
To evaluate the eligibility and efficacy of nalbuphine as a intravenous narcotic adjuvant for cardiac anesthesia, we selected 24 adult cardiac patients and divided them into 3 groups. Valvular surgerys were performed for group I patients,
aorto-coronary-bypass surgerys(CABG)for group Ⅱ and correction of congenital heart disease for groupⅢ, respectively. All patients were inducted general anesthesia with 0.3mg/kg nalbuphine+0.1mg/kg diazepam+2 mg/kg thiopental sodium and
maintained
with
intermittent injection of 0.3-0.5mg/kg nalbuphine and 0.1mg/kg diazepam just before the time of most stressful surgical stimuli with 1/2 MAC halothane inhalation under vecuronization for muscle relaxation.
We measured heart rate(HR), systolic blood pressure(BP), central venous pressure(CVP) at pre-induction as a control data, and just after endotracheal intubation, skin incision, sternotomy, and skin closure respectively to compare basic
cardiovascular
responses of patients at surgical stimuli with control data. We also checked recovery time of consciousness and presence of awareness during operation.
@ES The results were as follows:
@EN 1) Significant HR changes occurred in group I at just after intubation time from 104(18.6to134(25.9 and in group Ⅱ from 83(10.5 to 115(32.3 respectively.
2) There were few significant changes of systolic blood pressure during anesthesia of all groups except just after intubation in group Ⅱfrom 135(32.8 torr to 168(37.9 torr.
3) A significant CVP decrease occurred only in group I at the time of skin closure from 13(3.5 cmH2O to 10(3.8 cmH2O because of operative correction of tricuspid regurgitation of group I patients rather than anesthesia effects.
4) Recovery of consciousness needed average 1 hr 30 mins in group I and 2 hr 45 mins in group Ⅱ.None of patients complained awareness during operations.
Above results demonstrate that Nalbuphine-Diazepam-O2-1/2 MAC Halothane can be a anesthetic method for open heart surgery without any significant cardiovascular responses at surgical and anesthetic stimulin except intubation stimulus, but for
more
evaluation study of Nalbuphine-Diazepam-O2 Anesthesia will be needed.
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