Venkatesh B G, Mehta Yatin, Kumar Anand, Trehan Naresh
Department of Anaesthesiology & Critical Care, Escorts Heart Institute and Research Centre, New Delhi.
Ann Card Anaesth. 2007 Jan;10(1):46-50. doi: 10.4103/0971-9784.37924.
Maintenance of anaesthesia with volatile anaesthetic agents affects the perioperative course of patients undergoing off-pump coronary artery bypass (OPCAB) surgery. This facilitates adequate depth of anaesthesia, reduction in need of analgesic dosage, early extubation and transfer from Intensive Care Unit. We compared two volatile anaesthetic agents sevoflurane and isoflurane in terms of haemodynamic effects, amount of analgesic needed during surgery, quantity of agent needed for maintenance of anaesthesia and postoperative recovery in 40 patients undergoing OPCAB surgery. Anaesthesia was induced with fentanyl, midazolam and thiopentone, and vecuronium was used for muscle relaxation. An Octopus stabiliser was used and coronary anastomosis was performed using internal mammary artery and saphenous vein grafts. Routine monitoring was performed. The depth of anaesthesia was monitored using Bispectral index monitor. The inspired/expired concentration of anaesthetic agents to maintain the desired BIS and the amount of volatile anaesthetic agent needed was also noted. The amount of analgesic used intraoperatively was noted in both the groups. The 'time of awakening' defined as eye opening on verbal commands, and time of extubation were noted. There were no differences in haemodynamic parameters, depth of anaesthesia, and quantity of agent needed, but patients in isoflurane group required more intraoperative analgesics than sevoflurane group. Time of awakening (48+/-13 vs 114 +/- 21 mins; P < 0.001) and subsequent extubation (124 +/- 25 vs 177 +/- 36 mins, P<0.001) was earlier in sevoflurane group than isoflurane group. There was no evidence of perioperative myocardial infarction in both the groups. We conclude that sevoflurane and isoflurane can both be safely used in OPCAB surgery, but the awakening and extubation times are significantly less with sevoflurane.
使用挥发性麻醉剂维持麻醉会影响非体外循环冠状动脉搭桥术（OPCAB）患者的围手术期过程。这有助于实现足够的麻醉深度，减少镇痛药物剂量需求，早期拔管以及从重症监护病房转出。我们比较了七氟醚和异氟醚这两种挥发性麻醉剂对40例行OPCAB手术患者的血流动力学影响、手术期间所需镇痛药物量、维持麻醉所需麻醉剂用量以及术后恢复情况。麻醉诱导采用芬太尼、咪达唑仑和硫喷妥钠，维库溴铵用于肌肉松弛。使用章鱼稳定器，采用乳内动脉和大隐静脉移植物进行冠状动脉吻合。进行常规监测。使用脑电双频指数监测仪监测麻醉深度。记录维持所需脑电双频指数（BIS）时吸入/呼出麻醉剂浓度以及所需挥发性麻醉剂用量。记录两组术中使用的镇痛药物量。记录“苏醒时间”（定义为对言语指令有睁眼反应的时间）和拔管时间。两组在血流动力学参数、麻醉深度和所需麻醉剂用量方面无差异，但异氟醚组患者术中所需镇痛药物比七氟醚组更多。七氟醚组的苏醒时间（48±13分钟 vs 114±21分钟；P<0.001）和随后的拔管时间（124±25分钟 vs 177±36分钟，P<0.001）比异氟醚组更早。两组均无围手术期心肌梗死的证据。我们得出结论，七氟醚和异氟醚均可安全用于OPCAB手术，但七氟醚组的苏醒和拔管时间明显更短。
