Hemodynamic, Hepatorenal, and Postoperative Effects of Desflurane-Fentanyl and Midazolam-Fentanyl Anesthesia in Coronary Artery Bypass Surgery

Abstract

The purpose of this study was to compare the hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia during coronary artery bypass surgery. Prospective study. University hospital. Sixty patients undergoing elective coronary artery bypass grafting surgery with ejection fraction more than 45%. Anesthesia was induced with etomidate, 0.2 mg/kg, and fentanyl, 5 microg/kg, in group D (n = 30) and with midazolam, 0.1 to 0.3 mg/kg, and fentanyl, 5 microg/kg, in group M (n = 30). Anesthesia was maintained with desflurane, 2% to 6%, and fentanyl, 15 to 25 microg/kg, in group D and midazolam infusion, 0.1 to 0.5 mg/kg/h, and fentanyl, 15 to 25 microg/kg, in group M. Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Data were obtained before induction of anesthesia (t0), after induction of anesthesia (t1), after intubation (t2), after surgical incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine infusion (t6), and at the end of the surgery (t7). Blood samples were obtained to measure total bilirubin, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, creatinine, and blood urea nitrogen just before induction of anesthesia and at the first, fourth, and 14th days postoperatively. Intraoperative hemodynamic responses were similar in both groups, and transient hepatic and renal dysfunctions were observed in the postoperative period in both groups. The extubation and intensive care unit discharge times were found to be shorter in the desflurane-fentanyl group.