Induction of anaesthesia in patients with coronary artery disease: A comparison between sevoflurane-remifentanil and fentanyl-etomidate

In a prospective, randomized study, sevoflurane-remifentanil (Group SR) was compared with fentanyl-etomidate (Group FE) for induction of anaesthesia i n patients with ischaemic heart disease, Cardiovascular stability, heart ra te, mean arterial pressure, rate pressure product, rescue medications and a ssociated myocardial ischaemia were measured For Group SR (n = 20), anaesth esia was induced with vital capacity breaths of sevoflurane 5% in oxygen. A fter loss of consciousness, the inspired sevoflurane was reduced to 3% and remifentanil was administered as a 0.5 mu g.kg(-1) bolus over 90 seconds (0 .33 mu g.kg(-1).min(-1)) followed by a 0.025 mu g.kg(-1).min(-1) infusion. After intubation, the inspired sevoflurane was reduced to 2%, For Group FE (n=20), anaesthesia was induced with fentanyl 10.5 mu g.kg(-)1 and etomidat e 0.2 mg.kg(-1) given 60 seconds later: Isoflurane 1% in oxygen was adminis tered after loss of consciousness. Both groups received rocuronium and the trachea was intubated two minutes later: Sevoflurane gaseous induction was smooth, with cardiovascular stability comparable to fentanyl-etomidate. Sig nificantly more patients in Group SR (P<0.05) were on beta-blocking medicat ion, and overall, the HR and RPP was lower pre-intubation in Group SR. Remi fentanil administration was associated with severe bradycardia in three pat ients and asystole in a fourth. All four patients were on beta-blocking med ication and three of the four were on diltiazem. The study was terminated d ue to the high incidence of bradycardic/asystolic complications in Group SR .