COMPARISON OF SUFENTANIL-PROPOFOL ANESTHE SIA WITH FENTANYL-PROPOFOL ANESTHESIA IN PATIENTS UNDERGOING MAJOR ABDOMINAL-SURGERY

Major abdominal surgery often leads to a marked sympathoadrenal stress response with high concentrations of plasma catecholamines, hypertens ion, and tachycardia. We compared the effects of sufentanil-propofol w ith fentanyl-propofol anaesthesia in a controlled, randomised, double- blind study of 18 ASA I-II patients aged 23-64 years undergoing major abdominal surgery. Study parameters were haemodynamics (heart rate [HR ], arterial [ABP], central venous, and pulmonary arterial pressures, c ardiac index [CI]), arterial catecholamine concentrations, and the med ian frequency of the electroencephalopram (EEG) power spectrum. Method s. After premedication with flunitrazepam 1-2 mg, promethazine 25-50 m g, and piritramide 7.5-15 mg, a five-lead electrocardiograph and a Lif escan brain activity monitor were attached and indwelling cannulae wer e inserted into the radial artery and two forearm veins. A thermodilut ion catheter was placed in the pulmonary artery via the right internal jugular vein. Anaesthesia was induced with either fentanyl 7 mu g/kg followed by 5 mu g/kg . h or sufentanil 1 mu g/kg followed by 0.7 mu g /kg . h up to the end of surgery. Additional boli of the opioids were given according to set criteria, resulting in an average consumption o f 9.03 mu g/kg . h fentanyl or 1.22 mu g/kg . h sufentanil. Propofol 2 mg/kg was given followed by 6 mu g/kg . h up to the end of surgery. R elaxation was obtained with pancuronium 0.025-0.05 mg/kg before intuba tion and every 60-120 min. Measurements were performed before and afte r induction, after tracheal intubation, before and after skin incision , after opening of the peritoneum, and at the end of surgery. Results. No significant differences were observed between the two groups with regard to the study parameters. The duration of surgery and blood loss were similar in both groups, as were patient characteristics. After i nduction 2 patients in each group developed thoracic rigidity, which w as reversible after muscle relaxation. HR, ABP, and CI decreased signi ficantly before skin incision; after surgical stimulation the baseline values were again reached, but not exceeded. No patient developed tac hycardia (> 100/min) or hypertension (> 15% higher than baseline press ure) for longer than 10 min during the study period until the end of s urgery. The plasma concentrations of epinephrine and norepinephrine de creased significantly during anaesthesia, and under maximum surgical s timulation did not increase higher than the physiological baseline con centrations. The EEG median frequencies decreased after induction, and during the entire anaesthetic period the main activity was in the del ta and theta frequency bands. Conclusions. With both regimens, the sym pathoadrenal stress response to major abdominal surgery was nearly com pletely suppressed, resulting in stable haemodynamics during the opera tions. Sufentanil and fentanyl were equally well suited as analgesic c omponents of total IV anaesthesia with propofol.