High-dose Fentanyl Anesthesia Research Articles

High dose Fentanyl anesthesia for aorto-coronary bypass surgery

The adverse effects of high dose Fentanyl were compared with those of Morphine, given to 48 patients undergoing aorto-coronary bypass surgery from January to August 1981. In ten patients among the Fentanyl group, their cardiovascular dynamics during the induction of Fentanyl anesthesia were evaluated using Swan-Ganz catheters at the dose of 25μg/kg, 50μg/kg, 70μg/kg.M.A.P., C.I., S.V.I., L.V.S.W.I. were decreased significantly at each dose, therefore the cardiovascular depressant effect by high dose Fentanyl was revealed. But the more stable cardiovascular conditions during anesthesia, were given by high dose Fentanyl anesthesia than Morphine anesthesia, although 33% of patients anesthetized by Fentanyl, became hypotensive during the induction, and 36% of those had hypertension and/or tachycardia on pulling epicardium.Despite of them, the high dose Fentanyl anesthesia is recommended for the aorto-coronary bypass surgery.

EFFECT OF HIGH-DOSE FENTANYL ANAESTHESIA ON THE METABOLIC AND ENDOCRINE RESPONSE TO CARDIAC SURGERY

The effect of high-dose fentanyl anaesthesia (75 micrograms kg-1) on the metabolic and endocrine responses to cardiac surgery was compared with results obtained in similar patients who had received incremental doses of papaveretum. High-dose fentanyl anaesthesia prevented the increases in blood glucose, plasma cortisol and plasma growth hormone concentrations found before cardiopulmonary bypass, but during cardiopulmonary bypass was only effective in decreasing the hyperglycaemia. The continued administration of fentanyl following operation failed to suppress the hormonal and metabolic changes so that the total urinary excretion during the first 5 days after surgery was similar in both groups of patients. High-dose fentanyl anaesthesia was associated with only transient metabolic benefits confined to the period during operation.

Effects of high-dose fentanyl anesthesia on the electroencephalogram.

The purpose of this study was to define the EEG changes produced in humans by fentanyl 30-70 microgram/kg during cardiac surgery. The authors have also assessed awareness in the patients. Thirty-nine patients were studied; oral lorazepam or intramuscular morphine was used as premedication. Anesthesia was induced with intravenous injection of fentanyl over 2 min and the patients were ventilated with either air/O2 (24 patients) or N2O/O2 (15 patients). The EEGs recorded until the start of cardiopulmonary bypass were visually analyzed, classified into EEG stage, and plotted graphically as narcograms. Computerized 3-dimensional power spectral analysis and wide band spectral analysis were carried out on representative EEGs. The EEG effects of fentanyl are consistent and are characterized by high-voltage slow delta waves. Nitrous oxide had no effect on the EEG responses to fentanyl. Computer analysis confirmed the visual interpretation. There was no incidence of awareness. The authors conclude from this study that fentanyl after premedication is a suitable drug for providing unconsciousness, analgesia, and amnesia during cardiac surgery.

HORMONAL RESPONSES TO HIGH-DOSE FENTANYL ANAESTHESIA: A study in patients undergoing cardiac surgery

The hormonal responses to anaesthesia and cardiac surgery were studied in 20 patients. Ten patients were anaesthetized with fentanyl 60 microgram kg-1 and nitrous oxide in oxygen and 10 with etomidate 0.3 mgkg-1 and nitrous oxide in oxygen plus halothane. There were no significant changes in cortisol, growth hormone or insulin concentrations in response to surgery in either group, although cortisol concentrations decreased during cardiopulmonary bypass. Both groups showed increases in prolactin concentrations. Patients anaesthetized with etomidate and halothane showed a significant increase in adrenaline and glucose concentrations not seen in the fentanyl group. Cardiopulmonary bypass was associated with marked increases in catecholamines in both groups.

Renal Function and Stress Response during Halothane or Fentanyl Anesthesia

The effects of anesthesia on hormonal stress response and renal function were measured before institution of cardiopulmonary bypass in two groups of patients undergoing elective coronary artery surgery. Group 1 (10 patients) received fentanyl, 100 microgram/kg, and N2O/O2; group 2 (12 patients) received halothane and N2O/O2. Patients in group 1 showed no significant changes in plasma levels of vasopressin, renin, or aldosterone during anesthesia or operation. This same group, however, demonstrated significant decreases in plasma levels of cortisol (8.4 +/- 1 to 4.2 +/- 1 microgram%, p less than 0.01), epinephrine (260 +/- 72 to 97 +/- 28 pg/ml, p less than 0.05), and norepinephrine (715 +/- 177 to 322 +/- 46 pg/ml, p less than 0.05) during operation. This was accompanied by an increase in urine volume (2.1 +/- 0.8 to 7.6 +/- 2 ml/min, p less than 0.05), a decrease in urine osmolality (610 +/- 82 to 166 +/- 60 mOsm/kg, p less than 0.01), and urine Na+ (54 +/- 12 to 16 +/- 4 meq/L, p less than 0.01) and no change in creatinine clearance. In contrast, in the group 2 patients during operation plasma levels of cortisol (11.7 +/- 2 to 31.1 +/- 2 microgram%, p less than 0.01), aldosterone (60 +/- 14 to 106 +/- 2 pg/ml, p less than 0.01), and vasopressin (10.4 +/- 1 to 23.3 +/- 3 pg/ml, p less than 0.01) all increased. This was accompanied by a significant decrease in creatinine clearance (148 +/- 52 to 92 +/- 12 ml/min/m2, p less than 0.05). The data demonstrate that high dose fentanyl anesthesia can significantly attenuate the hormonal stress response to operation and preserve renal function. They also suggest that decreases in renal function observed with anesthesia and operation may be a reflection of the hormonal changes associated with surgical stimulation.

High dose fentanyl anaesthesia with oxygen for aorto-coronary bypass surgery.

Ten patients were anaesthetized with 100 per cent oxygen and fentanyl l00 μg · kg-1 for aorto-coronary bypass surgery and studied during induction of anaesthesia and initial surgical stimulation. All patients were taking propranolol and nitrates preoperatively. The patients were pre-medicated with diazepam 0.15mg·kg-1 by mouth and morphine 0.15mg·kg-1 and scopolamine 0.4 mg intramuscularly. Intravenous, arterial and Swan-Ganz catheters were inserted under local anaesthesia, after which control measurements were taken of heart rate, systolic blood pressure, pulmonary capillary wedge pressure, stroke index, cardiac index, left ventricular stroke work index, systemic vascular resistance, rate pressure product, triple index, Pao2 and Paco2.Observations were repeated after fentanyl 50 μg·kg-1 and pancuronium 0.1mg·kg-1, tracheal intubation, a further 50 μg · kg-1 of fentanyl, skin incision and sternotomy.No significant changes from control values were seen in heart rate, central venous pressure or systemic vascular resistance. Systolic blood pressure and left ventricular stroke work index decreased significantly after fentanyl 50 μg·kg-1 left ventricular stroke work index staying below control for the remainder of the study. Pulmonary capillary wedge pressure, triple index and Paco2 decreased significantly after fentanyl 100 μg·kg-1 skin incision and sternotomy. Significant decreases were noted in rate pressure product after skin incision, stroke index after sternotomy and cardiac index after both skin incision and sternotomy.Oxygen and fentanyl l00 μg·kg-1 provided stable indices of myocardial oxygen demand during induction, tracheal intubation and initial surgical stimulation in patients undergoing aorto-coronary bypass surgery.

High Dose Fentanyl Anesthesia for Coronary Artery Surgery

LUNN, J. K.; STANLEY, T. H.; EISELE, J.; WEBSTER, L.; WOODWARD, A.; Boulanger, Marcel M.D. Author Information

High Dose Fentanyl Anesthesia for Coronary Artery Surgery

High Dose Fentanyl Anesthesia for Coronary Artery Surgery

Fentanyl-oxygen anaesthesia for coronary artery surgery: cardiovascular and antidiuretic hormone responses

This study demonstrates that large doses of fentanyl, as the sole anaesthetic with ventilation with oxygen, produces complete anaesthesia and minimal changes in cardiovasuclar dynamics in patients with coronary artery disease. It also indicates that high dose fentanyl anaesthesia blocks the increase in plasma anti-diuretic hormone and cardiovascular dynamics which are so common with morphine and other anaesthetic techniques during tracheal intubation and surgical stimulation in patients with coronary artery disease. Our findings suggest that fentanyl-oxygen anaesthesia is an attractive technique in patients with coronary artery disease.

Oxygen Affinity of Hemoglobin in Persons with Acute Myocardial Infarction and in Smokers

The hemoglobin-oxygen affinity of pure hemoglobin was studied in 11 patients with signs of myocardial ischemia or acute necrosis and in 12 controls. Additionally, the hemoglobin of a moderate and a heavy cigarette smoker without evidence of cardiovascular disease was studied. Under physiological pH conditions, the hemoglobin gave up oxygen in an abnormal manner in all except the 12 controls. In all control subjects and patients, the arterial saturation was normal and blood pH values were within normal limits. Electrophoretic abnormality was not found in any of the subjects studied. It is thus demonstrated that hemoglobin may be physicochemically abnormal without electrophoretic abnormality. From a functional point of view, the hemoglobin's abnormal response to changes in oxygenation may result from altered proton-binding properties of the hemoglobin molecule. That such "abnormal" hemoglobin could contribute to the paradox of myocardial ischemia or necrosis occurring in the presence of full arterial satura...