[Hemodynamics of coronary surgery patients under isoflurane and neuroleptanalgesia]

The haemodynamic effects of isoflurane- and modified neurolept-anaesthesia were evaluated in 24 patients undergoing coronary artery bypass grafting. 12 patients (isoflurane group) were anaesthetized after an induction with 1.5 mg/kg methohexital and a unique dose of 0.005 mg/kg fentanyl with isoflurane (0.5-1.5 Vol%), N2O/O2 and pancuronium. 12 patients (neurolept group) received fentanyl (0.04 mg/kg), flunitrazepam, pancuronium and N2O/O2. Haemodynamic measurements were made before anaesthesia, in steady state anaesthesia, after sternotomy, after extracorporal circulation, after thoracic closure and one, two and four hours after the end of the operation. Between both groups we could not find significant differences in the haemodynamic parameters RAP, PAP, PCWP, PVR, CI, SVI, AP and CPP. However in the isoflurane group the peripheral vascular resistance (TPR) was significantly lower in steady state anaesthesia and after sternotomy. In the neurolept group the heart rate (HR) was significantly higher after bypass than in the isoflurane group. We believe, that at this time fentanyl analgesia was reduced. Before extracorporal bypass, patients with isoflurane anaesthesia had a lower arterio-mixed venous oxygen content difference (AVDO2) than patients with neurolept anaesthesia. Therefore it can be supposed that isoflurane lowers the oxygen demand more than neurolept anaesthesia. After surgery neurolept anaesthetized patients showed postanaesthetic shivering more frequently than those in the isoflurane group. We suggest that the vasodilating effect of isoflurane induces a homogeneous heat gain during warming the patients up, and that, therefore, in patients of the isoflurane-group AVDO2 and TPR were lower than in the patients of the neurolept-group during the first postoperative hours.(ABSTRACT TRUNCATED AT 250 WORDS)