Canadian Anaesthetists' Society journal
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Comparative Study
Catecholamine and cortisol responses to sufentanil-O2 and alfentanil-O2 anaesthesia during coronary artery surgery.
The effects of alfentanil-O2 and sufentanil-O2 anaesthesia on plasma catecholamines and cortisol were investigated in 32 patients undergoing coronary artery bypass grafting operations. After lorazepam-atropine premedication and pancuronium pretreatment, alfentanil was given to 16 patients at a rate of 3 mg.min-1 and sufentanil was given to 16 patients at 300 micrograms.min-1 until the patients were unconscious; at this time they were given succinylcholine and were intubated. After intubation an amount of alfentanil or sufentanil equal to the dose producing unconsciousness was infused over the next 30 min, at which time the operation began. ⋯ During bypass both hormones became increased and remained increased at the end of operation. Plasma cortisol decreased after incision and remained decreased until the end of operation. These data indicate that alfentanil-O2 and sufentanil-O2 anaesthesia produce similar changes in plasma catecholamines and cortisol as does fentanyl-O2 anaesthesia and hormonal effects are, therefore, not an explanation for any advantages the newer narcotics may have over fentanyl.
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A case is presented of a female with respiratory distress who was initially treated as having asthma. Her chest x-ray was normal but tracheal tomograms revealed a tracheal tumour almost completely occluding the tracheal lumen. The impending tracheal occlusion was managed with femoral-femoral cardiopulmonary bypass instituted under local anaesthesia prior to induction of anaesthesia and diagnostic bronchoscopy and airway establishment with tracheal intubation. Other indications for the use of cardiopulmonary bypass prior to the induction of anaesthesia are reviewed.