COMPARISON OF SEVOFLURANE FENTANYL AND ISOFLURANE/FENTANYL DURING ELECTIVE CORONARY-ARTERY BYPASS-SURGERY/

Purpose: Due to the progressive aging of the surgical population, the proportion of patients with coronary artery disease (CAD) is likely to increase. The effects of the new inhalational anaesthetic sevoflurane must be determined in patients with known CAD. Methods: This multicen tre, randomized, open-label study compared the haemodynamic and cardio vascular effects of sevoflurane and isoflurane with fentanyl in 284 AS A physical status II-IV patients undergoing elective coronary artery b ypass graft (CABG). Results: Satisfactory records were available in 27 2 patients, 139 sevoflurane (Group S) and 133 isoflurane (Group I). Th ere were no differences between groups for demographic data except tha t more patients in Group S were taking preoperative beta-blockers (P = 0.03). The mean end-tidal MAC and MAC . hr requirements between group s were not different (Group S received 0.63 +/- 0.02 MAC and 1.00 +/- 0.05 MAC . hr while Group I received 0.58 +/- 0.02 MAC and 0.92 +/- 0. 05 MAC . hr P = NS). The preCPB use of intravenous fentanyl was not di fferent between groups. There was a similar decrease in haemodynamic v ariables in both groups after induction that persisted throughout the preCPB period. The incidence of preCPB myocardial ischaemia, adverse h aemodynamic events and use of vasoactive drugs did not differ between groups. The incidence of postoperative myocardial infarction was 2.2% for Group S and Group I was 4.5% (P = NS). There were five postoperati ve deaths, one of which was attributed to a cardiac cause (Group I). C onclusion: In patients undergoing elective CABG with low risk factors, either sevoflurane or isoflurane, combined with fentanyl, provided an acceptable preCPB haemodynamic profile and cardiac outcomes.