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Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Authors
  • Poterman, Marieke1
  • Kalmar, Alain F.1, 2
  • Buisman, Pieter L.1
  • Struys, Michel M. R. F.1
  • Scheeren, Thomas W. L.1
  • 1 University Medical Center Groningen, Hanzeplein 1, Groningen, RB, 9700, The Netherlands , Groningen (Netherlands)
  • 2 AZ Maria Middelares Gent Buitenring Sint-Denijs 30, Ghent, 9000, Belgium , Ghent (Belgium)
Type
Published Article
Journal
BMC Anesthesiology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Oct 07, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12871-020-01174-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundBalanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia.MethodsIn seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 μg ml− 1 and either sufentanil (TCI Cet 0.48 ng ml− 1) or remifentanil (TCI Cet 8 ng ml− 1). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO2) and peripheral (SptO2) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed.ResultsThe sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = − 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = − 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = − 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = − 0.8 (− 1.5 to − 0.5) vs. -1.5 (− 2.0 to − 1.1) l min− 1 m− 2), while SctO2 (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO2 (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min− 1 m− 2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO2 and ∆SptO2.ConclusionInduction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO2 compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids.Trial registrationClinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935).

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