Jyy. Wang et al., Induction of anaesthesia in patients with coronary artery disease: A comparison between sevoflurane-remifentanil and fentanyl-etomidate, ANAESTH I C, 27(4), 1999, pp. 363-368
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
.