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Dose-response to anaesthetic induction with sufentanil: haemodynamic and electroencephalographic effects

  • Jitender Sarecn
  • Robert J. Hudson
  • Morley Rosenbloom
  • Ian R. Thomson
Reports of Investigation

Abstract

Purpose

To determine the effect of a five-fold variation in sufentanil dose on the haemodynamic and electroencephalo graphic (EEG) response to anaesthetic induction and tracheal intubation.

Methods

Thirty-four patients undergoing elective coronary artery bypass grafting (CABG) participated in this randomized double-blind study. Patients in Group L (n= 17) received 3 μg · kg−1 sufentanil and those in Group H (n= 17) 15 μg · kg−1. Premedication was 60 μg · kg−1 lorazepam po. Anaesthesia and neuromuscular blockade were induced by infusing sufentanil and 0.15 mg · kg−1 vecuronium iv over five minutes. Haemodynamic data and the electroencephalographic (EEG) spectral edge were acquired by computer and compared at Control, Induction and Intubation.

Results

Sufentanil dose did not affect the haemodynamic or EEG response at end-induction. No bradyarrhythmias occurred, and the incidence of hypotension was 12% in both groups. However, during induction apparent electromyographic artifacts and a transiently greater increase in heart rate were observed in Group H. The serum sufentanil concentration at Induction was 6.1 ± 1.8 ng · ml−1 in Group L and 25.4 ± 8.8 ng · ml−1 in Group H, and did not correlate with haemodynamic changes. No patient recalled any intraoperative event.

Conclusion

Increasing sufentanil dose from 3 to 15 μg · kg−1 does not influence the ultimate haemodynamic response to induction. Combined with lorazepam premedication, 3 μg · kg−1 sufentanil produces near-maximal haemodynamic and EEG effects and is adequate for induction and tracheal intubation of patients undergoing CABG. Sufentanil 15 μg · kg−1 is no more efficacious, and causes transient cardiovascular stimulation.

Keywords

Fentanyl Coronary Artery Bypass Grafting Mean Arterial Pressure Sufentanil Pulmonary Capillary Wedge Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Déterminer les effets hémodynamiques et électroencéphalographiques (EEG) d’une dose quintuple de sufentanil sur l’induction de l’anesthésie et l’intubation de la trachée.

Méthodes

Trente-quatre patients subissant une chirurgie de revascularisation myocardique (CRVM) non urgente participaient à cette étude aléatoire conduite à double insu. Les patients du groupe L (n= 17) recevaient sufentanil 3 μg · kg−1 et ceux du groupe H (n = 17) 15 μg · kg−1. Tous étaient prémédiqués au lorazepam 60 μg kg−1 per os. L’anesthésie et la curarisation étaient initiées en perfusant le sufentanil et le vécuronium 0,15 mg kg−1 iv en cinq minutes. Les données hémodynamiques et l’EEG spectral comprimé étaient recueillies sur ordinateur et comparées à la phase de contrôle, à l’induction et au moment de l’intubation.

Résultats

Le sufentanil n’a pas eu d’effets hémodynamiques ou EEG à l’induction. On n’a pas observé de bradycardie et l’incidence d’hypotension a été de 12% pour les deux groupes. Cependant, pendant l’induction, des perturbations visibles à l’EEG et une augmentation transitoire plus importante de la fréquence cardiaque étaient observés dans le group H. La concentration sérique de sufentanil à l’induction était de 6, 1 ± 1, 8 ng ml−1 pour le groupe L et de 25, 4±8, 8 ng · ml−1 pour le groupe H et n’était pas en corrélation avec les changements hémodynamiques. Aucun des patients n’a mentionné un rappel d’événements peropératoires.

Conclusion

Laugmentation de la posologie du sufentanil de 3 à 15 mg kg−1 n’a pas d’unfluence sur la réponse hémodynamique en fin d’induction. Associé à une prémédication de lorazepam, le sufentanil 3 μg kg−1 produit des effets hémodynamiques et EEG presque maximaux et est adéquat pour l’induction et l’intubation de la trachée de patients subissant une CRVM. Le sufentanil 15 μg · kg−1 n’est pas plus efficace et provoque une stimulation cardiovasculaire transitoire.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Jitender Sarecn
    • 1
  • Robert J. Hudson
    • 1
  • Morley Rosenbloom
    • 1
  • Ian R. Thomson
    • 1
  1. 1.Department of AnesthesiaSt. Boniface General HospitalWinnipegCanada

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