What question did this study set out to answer?

To determine the anesthetic requirements and hemodynamic consequences of high-dose intravenous fentanyl with oxygen, alone and in combination with diazepam, in cardiac surgery patients.

July 1, 1978Anesthesia & Analgesia

Anesthetic Requirements and Cardiovascular Effects of Fentanyl-Oxygen and Fentanyl-Diazepam-Oxygen Anesthesia in Man

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Why the study?

Does the addition of diazepam to fentanyl-oxygen anesthesia alter cardiovascular dynamics in patients undergoing mitral valvular replacement?

Key Points

To determine the anesthetic requirements and hemodynamic consequences of high-dose intravenous fentanyl with oxygen, alone and in combination with diazepam, in cardiac surgery patients.
Evaluated 23 patients receiving IV fentanyl (up to 50 μg/kg) while breathing 100% oxygen prior to mitral valve replacement.
Administered 10 mg IV diazepam over 20 seconds to 10 patients following the fentanyl induction sequence.
Recorded hemodynamic parameters before and after incremental 10 μg/kg fentanyl doses and at 2, 4, 6, and 8 minutes following diazepam administration.
Unresponsiveness occurred at an average fentanyl dose of 11 ± 3 μg/kg, with total intraoperative requirements reaching 74 ± 10 μg/kg for fentanyl alone versus 69 ± 9 μg/kg for fentanyl plus diazepam.
Fentanyl alone at 20 μg/kg reduced heart rate and arterial blood pressure without significantly altering stroke volume, cardiac output, central venous pressure, or peripheral resistance, with no further changes at doses up to 50 μg/kg.
Addition of diazepam caused significant cardiovascular depression, decreasing stroke volume, cardiac output, blood pressure, and peripheral resistance while increasing central venous pressure without changing heart rate.

Structured PICO

Does the addition of diazepam to fentanyl-oxygen anesthesia alter cardiovascular dynamics in patients undergoing mitral valvular replacement?

Population

23 patients breathing O2 prior to mitral valvular replacement

Intervention

Fentanyl (up to 50 μg/kg IV) plus diazepam (10 mg IV)

Comparator

Fentanyl alone (up to 50 μg/kg IV)

Outcome

Cardiovascular dynamics (heart rate, arterial blood pressure, stroke volume, cardiac output, central venous pressure, peripheral arterial resistance)surrogate

Fentanyl-oxygen anesthesia produces minimal cardiovascular changes and may be an attractive alternative to morphine in patients with little cardiac reserve, whereas adding diazepam causes cardiovascular depression.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May warrant caution adding diazepam to fentanyl in mitral valve surgery; leaves open generalizability beyond this observational cohort.

Cite This Study

STANLEY et al. (1978) studied this question.

synapsesocial.com/papers/6a82daf1040bdabcf3470380 https://doi.org/10.1213/00000539-197807000-00008

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Anesthetic Requirements and Cardiovascular Effects of Fentanyl-Oxygen and Fentanyl-Diazepam-Oxygen Anesthesia in Man

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Anesthetic Requirements and Cardiovascular Effects of Fentanyl-Oxygen and Fentanyl-Diazepam-Oxygen Anesthesia in Man

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider