Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Jun 1990
Dopamine counteracts hypertension during general anesthesia and hypotension during combined thoracic epidural anesthesia for abdominal aortic surgery.
The influence of the degree of sympathetic nervous system activation on the cardiovascular effects of dopamine was studied during abdominal aortic surgery in 13 patients. The arterial plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous system activity. During anesthesia with nitrous oxide and fentanyl, 7 patients (group 1) had a NE above 700 pg/mL and an increased mean arterial pressure (MAP) compared with the preanesthetic level (150 +/- 6 v 117 +/- 10 mm Hg; p less than 0.01, mean +/- SEM). ⋯ This reduced MAP to 65 +/- 7 mm Hg (P less than 0.01) and 56 +/- 3 mm Hg (P less than 0.01), and NE to 441 +/- 76 (P less than 0.05) and 235 +/- 45 pg/mL (P less than 0.05) in groups 1 and 2, respectively. During TEA, dopamine increased MAP similarly in both groups, to 85 +/- 7 mm Hg (P less than 0.01) and 82 +/- 9 mm Hg (P less than 0.05), respectively. In conclusion, dopamine, at the same dosages, counteracted hypertension during general anesthesia and counteracted hypotension during general anesthesia combined with TEA.
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J Cardiothorac Anesth · Jun 1990
Sufentanil and succinylcholine for rapid-sequence anesthetic induction and tracheal intubation: hemodynamic and hormonal responses.
Rapid-sequence induction and tracheal intubation are used in the management of patients at risk of aspiration. Patients with coronary artery disease (CAD) are at additional risk of adverse hemodynamic responses to intubation. The hemodynamic and hormonal responses to intubation with sufentanil, 7 micrograms/kg, and succinylcholine, 1.5 mg/kg, were studied in patients with CAD and good left ventricular function (ejection fraction greater than or equal to 0.4) who were undergoing elective coronary artery bypass grafting. ⋯ Rapid-sequence administration of sufentanil and succinylcholine resulted in a moderate decrease (24%) in mean arterial pressure from 95 to 72 mm Hg, and the mean arterial pressure remained less than the control value at 1, 3, and 5 minutes after intubation. Systemic vascular resistance also decreased (23%) after administration of sufentanil and returned to control values 5 minutes after intubation. There were no changes in cardiac index until 5 minutes after intubation, at which time it decreased (18%) from 2.8 to 2.3 L/min/m2.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Cardiothorac Anesth · Apr 1990
Randomized Controlled Trial Comparative Study Clinical TrialA randomized double-blind comparison of fentanyl- and sufentanil-oxygen anesthesia for abdominal aortic surgery.
Twenty-four patients undergoing abdominal aortic surgery for aneurysm or occlusive vascular disease entered a randomized, double-blind protocol comparing high-dose narcotic anesthesia with fentanyl (125 micrograms/kg) or sufentanil (25 micrograms/kg). All patients received perioperative beta-adrenergic blockade therapy. Hemodynamic and electrocardiographic (leads II and V5) responses to induction, intubation, skin incision, aortic cross-clamping, and declamping were studied. ⋯ Mean plasma fentanyl concentrations varied between 7.2 +/- 1.4 ng/mL and 26.5 +/- 7.9 ng/mL, and mean sufentanil plasma concentrations varied between 1.0 +/- 0.1 ng/mL and 10.6 +/- 7.2 ng/mL throughout surgery. Within this range of narcotic serum levels, the authors were unable to identify a specific threshold level for either narcotic above which hemodynamic responses were consistently attenuated. A low incidence (4.5%) of intraoperative myocardial ischemia was observed.(ABSTRACT TRUNCATED AT 250 WORDS)