High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease.

Nine premedicated patients, chronically maintained on beta-adrenergic blocking agents and demonstrating good ventricular function without significant valvular or left main coronary artery disease, were investigated to determine their haemodynamic responses to rapid induction of anaesthesia and tracheal intubation during elective coronary artery bypass surgery. Fentanyl 50 micrograms X kg-1 and pancuronium 0.15 mg X kg-1 were administered intravenously over 20 seconds followed by tracheal intubation 90 seconds thereafter. The rapid sequence of anaesthetic induction and tracheal intubation was well tolerated by all patients. Though statistically significant changes were detected in heart rate, pulmonary capillary wedge pressure and systemic vascular resistance, these changes were small and not considered clinically significant and no signs of ischaemia were detected on the ECG. The present study demonstrates that high-dose fentanyl is capable of inducing anaesthesia rapidly and protecting against the haemodynamic changes associated with tracheal intubation.