Sufentanil and succinylcholine for rapid-sequence anesthetic induction and tracheal intubation: Hemodynamic and hormonal responses

Abstract

Rapid-sequence induction and tracheal intubation are used in the management of patients at risk of aspiration. Patients with coronary artery disease (CAD) are at additional risk of adverse hemodynamic responses to intubation. The hemodynamic and hormonal responses to intubation with sufentanil, 7 μg/kg, and succinylcholine, 1.5 mg/kg, were studied in patients with CAD and good left ventricular function (ejection fraction ≥0.4) who were undergoing elective coronary artery bypass grafting. Tracheal intubation occurred 60 seconds after administration of sufentanil and succinylcholine. Heart rate, systemic and pulmonary arterial pressures, pulmonary artery occlusion and central venous pressures, and cardiac outputs were measured at various time intervals before and after induction of anesthesia. Systemic vascular resistance and cardiac index were calculated. Arterial blood samples were drawn before and after anesthetic induction for the determination of catecholamine concentrations in serum. Rapid-sequence administration of sufentanil and succinylcholine resulted in a moderate decrease (24%) in mean arterial pressure from 95 to 72 mm Hg, and the mean arterial pressure remained less than the control value at 1, 3, and 5 minutes after intubation. Systemic vascular resistance also decreased (23%) after administration of sufentanil and returned to control values 5 minutes after intubation. There were no changes in cardiac index until 5 minutes after intubation, at which time it decreased (18%) from 2.8 to 2.3 L/min/m 2. There were no significant changes in the other hemodynamic variables at any time. One patient required treatment with ephedrine, 10 mg, for a decline in mean arterial pressure from 98 to 66 mm Hg and a decrease in heart rate from 69 to 44 beats/min, which occurred at 5 minutes after intubation. Serum catecholamine levels were unchanged after administration of sufentanil and succinylcholine at 1 and 3 minutes after intubation. There was no electrocardiographic evidence of myocardial ischemia during the study, and the patients did not recall intraoperative events.