[Propofol in coronary diseases. Haemodynamic evaluation of some anesthetic regimes]

The haemodynamic effect of two regimens of propofol-fentanyl anaesthesia versus a standard isoflurane-fentanyl anaesthesia were compared perioperatively in 30 patients with good left ventricular function undergoing coronary artery bypass grafting. Anaesthesia was induced in all patients with fentanyl 14 micrograms/kg, pancuronium 0.1 mg/kg, and thiopental 1 mg/kg. Anaesthesia was maintained: in 10 patients with a constant propofol infusion of 200 micrograms/kg/min during the pre-bypass period and fentanyl boluses of 1 mg when required (PH Group); in 10 patients with a variable propofol infusion (from 43.09 to 22.42 micrograms/kg/min) during the pre-bypass period and a fixed infusion of 10.47 micrograms/kg/min during the post-bypass period (PL group) in 10 patients with a 1% isoflurane administration throughout the intraoperative period (F Group). The analgesia in the PL and F Groups was obtained with a fentanyl infusion of 0.3 microgram/kg/min during the prebypass period, 0.11 microgram/kg/min during the postbypass period. PL Group patients received 0.06 microgram/kg/min of fentanyl during the first three hours of the intensive care unit (TI) stay. The PL Group showed a significant better haemodynamic control of oxygen consumption indexes; PH Group patients had a major myocardial depression, routinely requiring the use of cardiokinetic agents in the post-bypass period. Intraoperative opioid consumption was similar in all Groups whereas the F Group showed a significantly higher fentanyl requirement during the TI period.