TOTAL INTRAVENOUS ANESTHESIA USING PROPOFOL, GAMMA-HYDROXYBUTYRATE ORMIDAZOLAM IN COMBINATION WITH SUFENTANIL FOR PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-SURGERY

Total intravenous anaesthesia (TIVA) using propofol, gamma-hydroxybuty rate (GHB) or midazolam in combination with sufentanil was investigate d in 45 patients undergoing coronary artery bypass grafting (CABG). An aesthesia was induced with sufentanil, etomidate and pancuronium. Afte r endotracheal intubation, anaesthesia was continued with sufentanil ( 2 mu g kg(-1) h(-1)) for ail patients. Patients were randomized to rec eive supplementary propofol (2 mg kg(-1) h(-1), n=15), gamma-hydroxybu tyrate (20 mg kg(-1) h(-1), n=15) or midazolam (0.06 mg kg(-1) h(-1), n=15). Haemodynamic measurements were performed after induction and at various times in the pre-bypass period. In the propofol group, a sign ificant decrease in heart rate (HR 12% +/- 3%), cardiac index (CI 23% +/- 4%), mean arterial pressure (MAP 16%+/-3%) and left ventricular st roke work index (LVSWI 17%+/-4%) occurred until sternotomy was perform ed. With the exception of cardiac index, both midazolam and gamma-hydr oxybutyrate produced similar haemodynamic effects: cardiac index was t emporarily decreased (19% +/- 4%) by midazolam and remained unchanged after gamma-hydroxy butyrate. In both groups, sternotomy was followed by temporary hypertension, associated with a significant rise in syste mic vascular resistance. No electrocardiographical signs of ischaemia were observed in any patient. In the case of propofol and midazolam, g amma-hydroxybutyrate showed adequate haemodynamic stability especially after induction of anaesthesia and may also be a suitable agent for t otal intravenous anaesthesia in patients with coronary artery disease. However, during sternotomy, supplementary administration of opioids w as required.