A comparison of fentanyl and sufentanil in patients undergoing coronary artery bypass graft surgery

Objective: To compare fentanyl and sufentanil, administered in equipotent c oncentrations by target-controlled infusion, as components of a balanced an esthetic in patients undergoing coronary artery bypass graft (CABG) surgery . Design: A prospective, randomized, double-blind trial. Setting: A university hospital. Participants: Twenty-one patients undergoing nonemergent, primary CABG surg ery. Interventions: Patients received fentanyl (group F, n = 10) or sufenta nil (group S, n = 11) by target-controlled infusion throughout the pre-card iopulmonary bypass (CPB) period. To ensure equipotency, the target effect-s ite concentrations employed (fentanyl, 8.1 ng/mL, and sufentanil, 0.68 ng/m L) were equal to the IC50 for electroencephalographic effect. Isoflurane wa s administered as needed to maintain pre-CPB hemodynamics near preoperative baseline values. Measurements and Main Results: Hemodynamics and endtidal isoflurane concent ration were measured every 15 to 30 seconds. Serum opioid concentrations we re measured 5 times between induction and CPB. Opioid cost was based on the number of ampules opened to provide the administered dose. The 2 groups we re similar demographically. The pre-CPB serum opioid concentrations were co nstant and averaged fentanyl, 5.8 +/- 1.9 ng/mL, and sufentanil, 0.59 +/- 0 .13 ng/mL. Pre-CPB hemodynamics were stable and similar in both groups. Pre -CPB end-tidal isoflurane requirements did not differ between groups and av eraged 0.46 +/- 0.21% in group F and 0.56 +/- 0.24% in group S. The duratio n of postoperative endotracheal intubation was 9.1 +/- 5.0 hours in group F and 8.0 +/- 3.2 hours in group S (p = NS). The cost per patient of fentany l (Canadian $6.12 +/- 1.04) was less than that of sufentanil (Canadian $17. 47 +/- 4.65). Conclusions: When administered in a constant 10:1 concentration ratio, fent anyl and sufentanil do not differ in their ability to facilitate pre-CPB he modynamic control. Although both opioids were relatively inexpensive, the a cquisition cost of fentanyl was less than sufentanil. A recommendation rega rding the opioid of choice for routine use in patients undergoing CABG surg ery awaits more rigorous studies of recovery and cost after equipotent dose s of fentanyl and sufentanil. When combined with isoflurane, effect-site op ioid concentrations near the IC50 for electroencephalographic effect provid e excellent pre-CPB hemodynamic control in patients undergoing CABG surgery . Copyright (C) 2000 by W.B. Saunders Company.