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January 1, 1986Anesthesia & Analgesia

Myocardial Metabolism and Hemodynamic Responses with Fentanyl-Enflurane Anesthesia for Coronary Arterial Surgery

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Why the study?

Does fentanyl-enflurane-oxygen anesthesia preserve myocardial oxygenation and hemodynamics in patients undergoing coronary vein grafting?

Population

10 patients undergoing coronary vein grafting, with preserved ventricular function and effective β-blockade.

Design

Case_series

Follow-up

24 hours postoperatively

Authors

EMEmerson A. MoffittTwitter (United States)AMAllan J. McIntyreCenovus Energy (Canada)RBRichard A. BarkerCenter for Global Development

Discussion

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Implication

Case report suggests preserved myocardial oxygenation with mild depression; leaves open randomized confirmation in CABG anesthesia.

Key Points

  • To evaluate hemodynamic stability, coronary blood flow, and myocardial oxygen metabolism during fentanyl-enflurane anesthesia in patients undergoing coronary artery bypass surgery.
  • Studied 10 patients with preserved ventricular function and effective β-blockade undergoing coronary vein grafting.
  • Administered fentanyl (30 μg/kg) followed by enflurane-oxygen titrated to reduce systolic blood pressure by 27% before intubation and maintained below awake levels.
  • Measured hemodynamics, coronary sinus blood flow, and myocardial oxygen and lactate extraction awake, at six intraoperative time points, and twice postoperatively.
  • Induction decreased systolic blood pressure and lowered stroke work index by 47% via reduced cardiac index without altering heart rate or systemic vascular resistance.
  • Coronary sinus blood flow decreased by 26% after intubation, while coronary sinus oxygen content increased by 30% and remained elevated before cardiopulmonary bypass.
  • Normal myocardial lactate extraction persisted after induction and increased pre-bypass, though extraction decreased post-bypass with 1 to 2 patients producing lactate within 24 hours.

Structured PICO

Does fentanyl-enflurane-oxygen anesthesia preserve myocardial oxygenation and hemodynamics in patients undergoing coronary vein grafting?

P
Population
10 patients undergoing coronary vein grafting, with preserved ventricular function and effective β-blockade.
I
Intervention
Induction of anesthesia with fentanyl (30 μg/kg), followed by enflurane-oxygen.
O
Outcome
Hemodynamic functions, myocardial blood flow, and oxygenationsurrogate

Fentanyl-enflurane-oxygen anesthesia maintains steady mild hemodynamic depression and preserves myocardial oxygenation during coronary artery bypass surgery.

Cite This Study

Moffitt et al. (1986) studied this question.

synapsesocial.com/papers/6a90229bb71d06dae589d74dhttps://doi.org/10.1213/00000539-198601000-00007
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Haemodynamics and Myocardial Oxygenation during Anaesthesia for Coronary Artery Surgery: Comparison between Enflurane and High‐Dose Fentanyl Anaesthesia1985 · 22 citations
  2. 2Low-Dose Enflurane as Adjunct to High-Dose Fentanyl in Patients Undergoing Coronary Artery Surgery1987 · 10 citations
  3. 3The Effects of Nitrous Oxide on Myocardial Metabolism and Hemodynamics during Fentanyl or Enflurane Anesthesia in Patients with Coronary Disease1984 · 58 citations
  4. 4Anaesthesia for myocardial revascularisation1992 · 24 citations
  5. 5Hemodynamic Changes during Fentanyl—Oxygen Anesthesia for Aortocoronary Bypass Operation1981 · 117 citations