Propofol -fentanyl anaesthesia: a comparison with isoflurane-fentanyl anaesthesia in coronary artery bypass graft surgery.

The haemodynamic effects of propofol -fentanyl anaesthesia (n=25) were compared with isoflurane-fentanyl anaesthesia (n=25) in patients with normal left ventricular ejection fraction (>45%) undergoing coronary artery bypass graft surgery under cardiopulmonary bypass. In the propofol group (Group P), anaesthesia was induced with midoazolam 2.5 to 5.0 mg, fentanyl 5mg/kg, pancuronium 0.1 mg/kg and propofol 1-2 mg/kg and was maintained with propofol infusion 10 mg/kg/hr till sternotomy, followed by 3 mg/kg/hr till skin closure. In the inhalational group (Group I) anaesthesia was induced with midazolam, fentanyl, pancuronium in the same doses and sleep dose of thiopentone and was maintained with oxygen : nitrous oxide (50:50) and isoflurane (0.5-1%). Additional fentanyl 2.5 microg/kg was given before sternotomy. Haemodynamic measurements were made before induction, after induction, after sternotomy, after heparinisation, after release of aortic cross clamp, post-bypass, post-sternal closure and on arrival in the recovery room. Post-bypass the cardiac index was higher in Group P (2.90+/- 0.76 v/s 2.40 +/- 0.40, p <0.05). Similarly post-bypass stroke volume index was higher in Group P (379.32 +/- 6.31 v/s 26.78 +/- 6.24, p<0.05). Patients in Group P were extubated earlier as compared to Group I (379.50 +/- 69 min v/s 453.00 +/- 134 min, p<0.05). This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with normal left ventricular ejection fraction undergoing coronary artery bypass graft surgery.