Abstract
Although sufentanil in high doses may result in deep coma sufficient to conduct coronarybypass surgery painlessly in patients, its side effects, e.g., bradycardia and hypotension, may lead to complications in some patients. Since ketamine causes central sympathetic stimulation, we attempted to counteract the vagomimetic effects of sufentanil by ketamine. Anaesthesia was induced in patients, (n = 15), for elective coronary arterybypass surgery with 0.12 mg · kg−1 midazolam IV, followed by 1 mg · kg−1 ketamine and 0.6 μg · kg−1 sufentanil IV eight minutes later. Subsequently, pancuronium 0.1 mg · kg−1 was given to facilitate tracheal intubation. Three minutes later, the trachea was intubated, and ketamine 1 mg · kg−1 · hr−1 IV infusion was started. Incremental doses of 0.6 μg · kg−1 sufentanil were given whenever a greater than 15 per cent increase in ratepressure product was observed. The mean ± S.E.M. dose of sufentanil before cardiopulmonary bypass was 6.5 ± 0.6 μg · kg and 9.1 ± 0.9 μg · kg for the entire procedure. Although midazolam alone caused reductions in systolic BP, SVR and LVSWI, other haemodynamic variables were not altered. The administration of this anaesthetic technique caused no clinically important adverse haemodynamic changes and/or STsegment changes and prevented the adverse haemodynamic changes caused by intubation, skin incision, sternotomy and periaortic dissection. Adequate analgesia, complete amnesia and early recovery of wakefulness were observed.
Résumé
Même si la sufentanil à haute dose peut amenér un coma profond suffisant pour une chirurgie coronarienne sans douleur chez les patients, les effets secondaires, tels que bradycardie et hypotension peuvent amenér des complications. Etant donné que la kétamine provoque une stimulation sympathique centrale on a tenté de contrecarrer les effets vagomimétiques du sufentanil par la kétamine. L’anesthésie fut induite chez les patients (n = 15) se présentant pour chirurgie coronarienne Elective avec 0.12 mg · kg−1 midazalam suivi de 1 mg · kg−1 de kétamine et 0.6 μg · kg−1 de sufentanil huit minutes plus tard. Par la suite du pancuronium 0.1 mg · kg−1 a été administré afin de faciliter l’intubation endotrachéale. Trois minutes plus tard la trachée fut intubée et la kétamine 1 mg · kg−1 · hr−1 en perfusion fut commencée. Des doses supplémentaires de 0.6 μg · kg−1 de sufentanil ont été administrées si le produit de la fréquence × pression augmentait de 15 pour cent. La dose moyenne de sufentanil avant la circulation extra corporelle était de 6.5 ± 0.6 μg · kg et 9.1 ± 0.9 μg · kg pour toute la procédure. Même si le midazolam seul a amené une diminution de la pression systolique, la résistance vasculaire systémique es de LVSWI, les autres données hémodynamiques ne furent pas altérées. L’administration de cette technique anesthésique n’a pas amené les altérations hémodynamiques clinique ou des altérations du segment-ST et a prévenu des changeéments hémodynamiques adverses lors de l’intubation, l’incision, la sternotomie et la dissection periaortique. Une analgésie adéquate, une amnésie complète et un réveil précoce furent observés.
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This study was conducted at the West Side Veterans Administration Hospital, Chicago, Illinois 60612. The opinions expressed in this paper in no way represent those of the United States Armed Forces or the Veterans Administration.
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Raza, S.M.A., Masters, R.W. & Zsigmond, E.K. Haemodynamic stability with midazolamketamine-sufentanil analgesia in cardiac surgical patients. Can J Anaesth 36, 617–623 (1989). https://doi.org/10.1007/BF03005410
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DOI: https://doi.org/10.1007/BF03005410