TOTAL INTRAVENOUS ANESTHESIA WITH SUFENTANIL MIDAZOLAM FOR MAJOR ABDOMINAL-SURGERY

Haemodynamic and endocrine stress responses were compared during total intravenous anaesthesia with sufentanil and midazolam or fentanyl and midazolam in patients undergoing elective major abdominal surgery. Tw enty-two ASA I and II patients were allocated randomly to receive sufe ntanil (induction 1.5 mug kg-1 plus infusion 1.5 mug kg-1 h-1) or fent anyl (induction 10 mug kg-1 plus infusion 10 mug kg-1 h-1) supplemente d with 0.15 mug kg-1 sufentanil or 1 mug kg-1 fentanyl as necessary. M idazolam was infused to obtain plasma concentrations of 500-600 ng ml- 1. Ventilation was with oxygen-enriched air. The opioid infusion was r educed post-operatively by half and benzodiazepine effects were revers ed by titration with flumazenil. Mean arterial pressure, heart rate an d cardiac index decreased in both groups after induction (cardiac inde x: sufentanil 4.94 +/- 0.45 to 2.99 +/- 0.18 litre min-1; fentanyl 4.9 7 +/- 0.45 to 3.71 +/- 0.36 litre min-1), but all returned to baseline during surgery. With sufentanil, mean arterial pressure was lower thr oughout the study period, and heart rate was lower intra-operatively. Oxygen uptake decreased in both groups after induction (sufentanil 289 +/- 29 to 184 +/- 21 ml min-1; fentanyl 318 +/- 32 to 216 +/- 32 ml m in-1) and remained low with sufentanil until flumazenil was given. Adr enaline concentrations increased in both groups but there was no inter group difference. The median noradrenaline concentration was lower int ra-operatively with sufentanil (0.47 nmol litre-1 (range 0.06-6.77)) t han with fentanyl (0.73 nmol litre-1 (0.07-4.58)). Cortisol, glucose a nd lactate concentrations increased in both groups. Bradycardia occurr ed in four patients with sufentanil and in three with fentanyl. There were two cases of marked thoracic rigidity with sufentanil and one wit h fentanyl.