Abstract
Fentanyl-oxygen (fentanyl-02) anaesthesia was compared to fentanyl-nitrous oxide/oxygen (fentanylN20I02) anaesthesia in 14 children undergoing cardiac surgery. Children were randomly assigned to one of the two techniques studied, with seven patients in each group. The mean age (mean ± SE) was 3.9 ±0.75 years (0.5–8.25 years) and mean weight 14.7 ± 2 kg (3.5– 29.5 kg). Patients were premedicated with IM atropine 0.02 mg’kg’-1 and morphine 0.2 mg·kg’-11 hour preoper-atively. They received a fentany I bolus of 30 μg·kg’-1 with a concomitant continuous infusion of 0.3μg·kg-1·min-1. Pancuronium 0.l mg·kg-1 was administered immediately following the fentanyl bolus. Fifty per cent nitrous oxide was given with oxygen in one group and 100 per cent oxygen was administered to the other group. Fentanyl plasma concentrations were similar in the two groups at the various stages of surgery. There were no significant differences between the two treatment groups in systolic and diastolic blood pressure or in heart rate in response to induction, intubation, and incision. There was a significantly greater increase in systolic blood pressure after sternotomy in thefentanyl-O2 group, in addition, in six of seven patients recieving fentanyl-O2 there were events of sudden increase in blood pressure during various stages of surgery before the bypass, necessitating an additional fentanyI bolus or the addition ofdroperidol in four cases. Similar phenomena were not documented in the fentanyl-N2OIO2 group. Our studies suggest that fentanyl-O2 anaesthesia in the schedule described, in children undergoing elective cardiac surgery for Tetralogy of F allot, A-V canal, and transposition of the great arteries, is not sufficient to prevent elevation in systolic blood pressure despite fentany I plasma concentrations in excess of 20 mg·ml-1. The addition of nitrous oxide prevents this phenomenon.
Résumé
L’anesthésie au fentanyl-oxygène (fentanyl-O2) a été comparée au fentanyl-protoxide d’azote/oxygène (fentanyl-N2O/O2) chez 14 enfants devant subir une chirurgie cardiaque. Les enfants ont été choisis au hasard par rapport à l’agent utilisé et divisés en deux groupes de sept. L’âge moyen (moyenne ± SE) était de 2.9 ± 0.75 ans (0.5–8.25 ans) et le poids moyen 14.7 ± 2 kg (3.5–29.5 kg). Les patients étaient prémédiqués avec l’atropine 0.02 mg·kg-1 et la morphine 0.2 mg·kg-1 deux heures avant l’opération. Ils ont reçu dufentanyl en bolus de 30 μg·kg-1 suivi d’une perfusion continue de 0.3 μg·kg-1·min-1. Le pancuronium 0.1 mg·kg-1 a été administré immédiatement après l’injection du bolus de fentanyl. Cinquante pour cent de protoxyde d’azote a été administré avec l’oxygène pour un groupe et 100 pour cent d’oxygène pour l’autre. Les concentrations plasmatiques de fentanyl ont été similaires dans les deux groupes aux différentes étapes de la chirurgie. Il n’y avait aucune différence significative entre les deux groupes tant qu’à la pression artérielle systolique et diastolique ni dans la fréquence cardiaque en réponse à l’induction, l’intubation ou l’incision. Il y avait cependant une augmentation signification de la pression artérielle systolique après sternotomiepour le groupe fentanyl-O2. En plus chez six des sept patients recevant dufentanyl-O2 on observa des épisodes d’augmentation de la pression artérielle durant les différentes étapes de la chirurgie avant la CEC, nécessitant une administration additionnelle de bolus de fentanyl ou l’administration de dropéridol chez quatre patients. Des phénomènes identiques n’ont pas été documentés chez les groupes recevant le fentanyl-N2O/O2. Nos études suggèrent que l’anesthésie au fentanyl-O2 tel que décrite chez les enfants subissant une chirurgie cardiaque pour une Tétralogie de Fallot, un canal A-V, ou une transposition des gros vaisseaux n’est pas suffisante afin de prévenir ;’élévation dans la pression artérielle systolique malgré les concentrations plasmatiques de fentanyl en excès de 20 ng·ml-1. L’addition de protoxyde d’azote prévient ce phénomène.
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This study was supported by a grant from Janssen Pharmaceutica, Ltd. Canada.
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Crean, P., Koren, G., Goresky, G. et al. Fentanyl-oxygen versus fentanyl-N2O/ oxygen anaesthesia in children undergoing cardiac surgery. Can Anaesth Soc J 33, 36–40 (1986). https://doi.org/10.1007/BF03010906
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DOI: https://doi.org/10.1007/BF03010906