Comparison of anesthetic techniques in patients undergoing heart valve replacement

A prospective study of 324 adult patients undergoing operations requiring cardiopulmonary bypass for heart valve replacement was undertaken to determine the effect of anesthetic technique on outcome. Patients received one of three primary techniques: fentanyl (40-100 micrograms/kg), sufentanil (4-8 micrograms/kg), or diazepam (0.4-1 mg/kg) with ketamine (3-6 mg/kg). Supplemental inhalation anesthesia with enflurane, halothane, or isoflurane was used in 43.8% of cases. Patients in these anesthetic groupings had similar perioperative demographic and risk classifications. Although there were differences in the requirements for vasopressors postoperatively among the intravenous anesthetic agents, neither mortality rates, length of ICU stay, nor incidence of postoperative heart failure showed the advantage of any intravenous or inhalational agent. There were also no significant differences in the incidences of serious pulmonary, renal, or neurologic morbidity among primary anesthetic techniques nor among supplemental inhalation agents. Multivariate discriminant analysis of these data suggests that many factors are significantly more important than anesthetic technique as determinants of outcome after heart valve replacement.