Sufentanil is preferable to etomidate during rapid-sequence anesthesia induction for aortocoronary bypass surgery

To evaluate rapid-sequence anesthetic induction techniques for aortocoronary bypass grafting, 20 patients scheduled for elective surgery were randomly assigned to receive bolus injections of either etomidate, 0.4 mg/kg, intravenously (IV), or sufentanil, 5 micrograms/kg, IV, with succinylcholine, 1 mg/kg, IV. Patients in the two groups had similar demographic characteristics and baseline (preinduction) hemodynamic values. Following induction and intubation, 8 of 9 etomidate patients required a pharmacologic intervention to treat hypertension and tachycardia, whereas only 1 of 11 sufentanil patients required additional treatment (P less than 0.001). Three of 9 etomidate patients had ST segment changes of new myocardial ischemia following induction and intubation; two other etomidate patients developed Q waves on their postoperative electrocardiograms, indicative of a perioperative myocardial infarction. No sufentanil patient demonstrated either ischemia or infarction. It is concluded that sufentanil-succinylcholine provides more stable hemodynamics and fewer ischemic myocardial events than etomidate-succinylcholine in patients undergoing myocardial revascularization surgery.