PROPOFOL-ALFENTANIL VERSUS FENTANYL-MIDAZOLAM IN CORONARY-ARTERY SURGERY

Objectives: To compare intraoperative hemodynamic profiles and recover y characteristics of propofol-alfentanil with fentanyl-midazolam anest hesia in elective coronary artery surgery. Design: Prospective, random ized study. Setting: University hospital. Participants: Fifty patients with impaired or good left ventricular function. Interventions: In gr oup 1, (n = 25) anesthesia was induced with an infusion of propofol, 3 to 4 mg/kg/h, alfentanil, 500 mu g, and pancuronium, 0.1 mg/kg, and m aintained with propofol, 3 to 6 mg/kg/h (variable rate), and alfentani l infusions, 30 mu g/kg/h (fixed rate). Additional boluses of alfentan il, 1 mg, were administered before noxious stimuli; group 2 (n = 25) r eceived a loading dose of fentanyl, 25 mu g/kg, midazolam, 1.5 to 3 mg , and pancuronium, 0.1 mg/kg for induction, followed by an infusion of fentanyl, 7 mu g/kg/h, for maintenance. Additional boluses of midazol am (1.5 to 3 mg) and fentanyl (250 mu g) were administered before noxi ous stimuli. Measurements and Main Results: Cardiovascular parameters at eight intraoperative time points as well as time to extubation, mor phine consumption, and pain scores were recorded. Induction of anesthe sia was associated in both groups with a small but significant decreas e in mean arterial pressure (1: 15 mmHg (15%); 2: 8 mmHg (8%) with sig nificant decreases in cardiac index (1: 8%; 2: 8%) and left ventricula r stroke work index (1: 24%; 2: 21%). Throughout surgery, hemodynamic profiles were comparable between groups except after intubation when t he MAP was significantly lower in group 1 (75 +/- 12 mmHg) than in gro up 2 (89 +/- 17 mmHg). Group 1 required less inotropic support. Extuba tion was performed faster in group 1 (7.6 h) than in group 2 (18.0 h). Morphine requirements and pain scores were comparable between groups. Conclusions: Propofol-alfentanil anesthesia provides good intraoperat ive hemodynamics and allows early extubation after coronary artery sur gery. Copyright (C) 1996 by W.B. Saunders Company