Hemodynamic variables and the incidence of prebypass ischemia during sufentanil/O2/pancuronium anesthesia in patients undergoing coronary artery surgery.

It has been suggested that sufentanil is a superior anesthetic to fentanyl for patients undergoing myocardial revascularization. This study was performed to determine the incidence of prebypass myocardial ischemia using sufentanil, 20 micrograms/kg for patients undergoing coronary artery bypass grafting (CABG). Twenty-seven patients with normal left ventricular function, scheduled for elective CABG, were studied. Anesthesia was induced with sufentanil, 10 micrograms/kg; and pancuronium, 0.1 mg/kg, was given for muscle relaxation. Further increments of sufentanil, 5 micrograms/kg, were given before skin incision and sternotomy. All patients had ECG leads V6 and V9 recorded continuously with a Holter monitor from arrival in the operating room until the start of bypass. Hemodynamic profiles were recorded at specific intervals in the prebypass period. Seven patients (25.9%) developed prebypass myocardial ischemia, three at intubation, and three at aortic dissection. Fourteen patients developed hypertension and 14 had hypotension, defined as increases or decreases greater than 20% from baseline values, respectively. Only five patients had neither hypotension nor hypertension. Three patients (11.1%) had perioperative myocardial infarctions, two of whom had prebypass myocardial ischemia. It is concluded that the incidence of prebypass ischemia with sufentanil anesthesia approximates 26%, which is similar to other studies using sensitive ECG monitoring techniques for the detection of ST segment changes. Hemodynamic instability, in the form of bradycardia, hypertension and hypotension, but not tachycardia, may have contributed to the incidence of prebypass ischemia.