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

Abstract

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. Fentany150 Ixg.kg-1 and pancuronium 0.15 mg.kg-1 were administered intra-venously 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.

Résumé

Neuf patients prémédiqués sous thérapie chronique aux bêta-bloquants et démontrant une bonne fonction ventriculaire sans atteinte valvulaire significative ou atteinte du tronc commun étaient investigués afin de déterminer leur réponse htémodynamique à l’induction rapide de l’anesthàsie et l’intubation trachàale durant le pontage aortocoronarien àlectif. Du fentanyl.50 µg..kg-1 et du pancuronium 0.15mg.kg-1 ont été administrés par vole intraveineuse en 20 secondes suivis 90 secondes plus tard par l’intubation trachéale. Cette séquence rapide d’induction anesthdsique et d’ intubation trachéale a été bien tolérée par tous les patients. Des changements statistiquement significatifs ont été détectés dans la fréquence cardiaque, la pression capillaire pulmonaire et la résistance vasculaire systémique. Cependant ces changements étaient minimes et considérés comme non cliniquement significatifs car aucun signe d’ischémie n’était détecté à l’électrocardiogramme. La présente étude démontre que de fortes doses de fentanyl étaient capables d’induire l’anesthésie rapidement et de protéger contre les changements hémodynamiques àl’sociés à l’ intubation trachéale.

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Author information

Correspondence to John M. Murkin or C. Craig Moldenhauer or Carl C. Hug.

Additional information

Presented in part at the Annual Meeting of the Canadian Anaesthetists’ Society, Winnipeg, Manitoba, June 1984.

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Murkin, J.M., Moldenhauer, C.C. & Hug, C.C. High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease. Can Anaesth Soc J 32, 320–325 (1985). https://doi.org/10.1007/BF03011334

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Key words

  • anaesthesia: cardiovascular
  • induction: anaesthesia
  • anaesthetics
  • intravenous: fentanyl