Journal of cardiothoracic anesthesia
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The combination of benzodiazepines and high-dose narcotics has been reported to produce hypotension in patients undergoing coronary artery surgery. This study was performed to evaluate the cardiovascular effects of lower doses of the narcotic sufentanil administered with the benzodiazepine midazolam. Thirty adult patients with good ventricular function undergoing elective coronary revascularization received sufentanil, 2.5 micrograms/kg, and midazolam, 0.1 mg/kg, followed by infusions of sufentanil, 0.7 to 1.5 micrograms/kg/h, and midazolam, 0.07 to 0.15 mg/kg/h. ⋯ Blood pressure decreases exceeding 20% of the baseline value did not occur. Two of 15 patients receiving beta-blockers, versus 3 of 15 not receiving beta-blockers, developed ischemic electrocardiographic changes before CPB (NS); one of these patients without beta-blockade had a postoperative myocardial infarction. The results of this study show that the infusion of low doses of sufentanil with midazolam provides a hemodynamically safe and stable anesthetic for coronary artery surgery and avoids the hypotension seen when a high-dose narcotic is combined with a benzodiazepine.