What is the clinical evidence from this study?

Study design: RCT. Population: Ischaemic heart disease (n=40). Intervention: Sevoflurane-remifentanil vs. Fentanyl-etomidate (fentanyl 10.5 mcg/kg and etomidate 0.2 mg/kg). Primary outcome: Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemia.

August 1, 1999Anaesthesia and Intensive Care

Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate

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Key result

Sevoflurane-remifentanil induction forces early termination in IHD patients due to severe bradycardia and asystole.

n=40

Why the study?

Does sevoflurane-remifentanil compared to fentanyl-etomidate improve cardiovascular stability during anaesthesia induction in patients with coronary artery disease?

Population

40 patients with ischaemic heart disease (coronary artery disease)

Comparison

Sevoflurane-remifentanil induction vs Fentanyl-etomidate induction

Design

RCT, Randomized

Follow-up

Peri-intubation period

Authors

JWJ. Y. Y. Wang SWS. M. Winship STSarah Thomas

Discussion

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Implication

Avoid sevoflurane-remifentanil induction in beta-blocked CAD patients; challenges presumed stability and supports etomidate-based alternatives.

Study Design

Type

RCT (n=40)

Structured PICO

Does sevoflurane-remifentanil compared to fentanyl-etomidate improve cardiovascular stability during anaesthesia induction in patients with coronary artery disease?

Population

40 patients with ischaemic heart disease undergoing induction of anaesthesia.

Intervention

Sevoflurane-remifentanil induction (sevoflurane 5% in oxygen reduced to 3% after loss of consciousness, remifentanil 0.5 mcg/kg bolus over 90 seconds followed by 0.025 mcg/kg/min infusion, reduced to 2% sevoflurane after intubation)

Comparator

Fentanyl-etomidate induction (fentanyl 10.5 mcg/kg and etomidate 0.2 mg/kg given 60 seconds later, followed by isoflurane 1% in oxygen after loss of consciousness)

Outcome

Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemiasafety

Sevoflurane-remifentanil induction in patients with coronary artery disease on beta-blockers is associated with a high risk of severe bradycardia and asystole compared to fentanyl-etomidate.

Limitations

Study was terminated early due to high incidence of bradycardic/asystolic complications in the sevoflurane-remifentanil group
Baseline imbalance with significantly more patients in the sevoflurane-remifentanil group on beta-blocking medication

Cite This Study

Wang et al. (1999) conducted an RCT in Ischaemic heart disease (n=40). Sevoflurane-remifentanil vs. Fentanyl-etomidate (fentanyl 10.5 mcg/kg and etomidate 0.2 mg/kg) was evaluated on Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemia. Induction of anaesthesia with sevoflurane-remifentanil in patients with ischaemic heart disease was terminated early due to a high incidence of severe bradycardia and asystole.

synapsesocial.com/papers/6aa46a92d71f4ae7aa181866 https://doi.org/10.1177/0310057x9902700405

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Implication

Avoid sevoflurane-remifentanil induction in beta-blocked CAD patients; challenges presumed stability and supports etomidate-based alternatives.

Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider