• Acta Anaesthesiol Taiwan · Sep 2007

    Randomized Controlled Trial

    Closed-circuit isoflurane-based anesthesia provides better fast-tracking anesthesia than fentanyl/propofol-based anesthesia for off-pump coronary artery bypass graft surgery.

    • Fang-Lin Chang, Shinn-Long Lin, Chien-Song Tsai, Chun-Chang Yeh, Ching-Tang Wu, and Chih-Shung Wong.
    • Department of Anesthesiology and Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan, ROC.
    • Acta Anaesthesiol Taiwan. 2007 Sep 1;45(3):135-9.

    BackgroundIn recent years, low-dose fentanyl combined with short-acting hypnotic drug has been thought to be better than traditional high-dose fentanyl in cardiac anesthesia. On the other hand, the practice of closed-circuit inhaled anesthesia offers many advantages, including hemodynamic stability, maintenance of adequate anesthesia depth and early recovery. This study sought to evaluate the effect of closed-circuit isoflurane-based anesthesia (CIA) and fentanyl/propofol-based anesthesia (FPA) on off-pump coronary artery bypass graft (OPCABG) surgery.MethodsFifty patients scheduled for elective OPCABG surgery were enrolled and randomly assigned to receive either CIA (n = 25) or FPA (n = 25). In the CIA group, anesthesia was induced with fentanyl 2 microg/kg and midazolam 0.05 mg/kg, followed by 2% isoflurane in oxygen (oxygen flow rate = 3 L/min) via mask ventilation for 30 min. Pancuronium 0.1-0.15 mg/kg was given thereafter to facilitate endotracheal intubation. Anesthesia was maintained by isoflurane in a minimal oxygen flow of 300 mL/min, with the vaporizer adjusted to deliver 3%-5% concentration. In the FPA group, anesthesia was induced with fentanyl 10-15 microg/kg and midazolam 0.05 mg/kg; and pancuronium 0.1-0.15mg/kg was used for endotracheal intubation. Anesthesia was maintained by propofol 2-6 mg/kg/hr and fentanyl 1-2 microg/kg/hr, and an incremental bolus of i.v. propofol 20 mg was given if the patient's mean blood pressure (MBP) exceeded 85 mmHg. An inotropic agent was given if the patient's MBP dropped below 65 mmHg or if the patient experienced a decrease in MBP greater than 20% of the preinduction value. The time of extubation, length of stay in the intensive care unit, and inotropic requirements were recorded.ResultsThe patients in the CIA group were extubated earlier than those in the FPA group (281.3 +/- 32.5 min versus 311.3 +/- 38.5 min, respectively; P < 0.05), although there was no statistical difference in the length of stay in the intensive care unit (29.6 +/- 4.8 hr versus 30.1 +/- 7.6 hr, respectively; P = 0.4). The use of inotropic agent in the CIA group was less than in the FPA group (16% vs. 56%, P < 0.01). Dopamine requirement was less in the CIA group than in the FPA group (0.8 +/- 0.3 vs. 3.7 +/- 0.4 microg/kg/min, respectively; P < 0.01).ConclusionsThese results suggest that CIA, as compared with FPA, provides a significant reduction in the time to extubation after OPCABG surgery with less use of inotropic agents.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

Want more great medical articles?

Keep up to date with a free trial of metajournal, personalized for your practice.
1,694,794 articles already indexed!

We guarantee your privacy. Your email address will not be shared.