Sufentanil On The Impact Of Off-pump Coronary Artery Bypass Patients With Vascular Graft Blood Flow Dynamics

Objective: Increasing interest is being shown in off-Pump Coronary Artery Bypass Surgery (OPCABG) because, compared with operations performed with cardiopulmonary bypass, OPCABG surgery may be associated with less physiological intervention, decreaced postoperative complications, fast recovery and reduced total costs. The maintenance of stable hemodynamics during operation is the most important thing of OPCABG anesthesia. Recently, with the implementation of fast-track anesthetic technique, How can we make patients early recovery, early awake and early extubation already became a focus. The aim of this study was to investigate the hemodynamic effects of sufentanil-based and fentanyl-based technique for off-Pump Coronary Artery Bypass Surgery, and estimate the time of awake , extubation.Methods: Fourty patients who were undergoing elective OPCABG surgery, were enrolled and randomly assigned to two groups of 20 patients each, sufentanil group and fentanyl group. All patients received the same inductive drug(midazolam,0.1-0.15mg/kg) and, when being asleep, the patients received the same muscle relaxant (pipecuronium, 0.2mg/kg). then fentanyl group received a loading dose of fentanyl, 10-15ug/kg over 1 minute, and anesthesia was maintained with infusions of fentanyl, 10ug/kg/h, propofol, 3mg/kg/h, and pipecuronium, 90ug/kg/h. sufentanil group received a loading dose of sufentanil, 1.0-1.5ug/kg over 1 minute, and anesthesia was maintained with infusions of sufentanil, 1.0ug/kg/h, propofol, 3mg/kg/h, and pipecuronium, 90ug/kg/h. The Swan-Gans catheter was placed in the right internal jugular vein after induction in all patients. All patients received infusion of dopamine, 120ug/kg/h. And when it was needed, we can adjust the dosage of dopamine. The hemodynamic data of both patients were recorded before anesthesia induction, after induction, sternotomy, 1 minute before OPCABG, 1 minute after OPCABG, and at the end of operation. The time of awake, extubation were recorded 24 hour postopratively.Results: Demographic and clinical characteristics were similar for the two groups. All patients were transferred to ICU safely, and extubated after awake without re-extubation later. Hemodynamic stability was obtained in both groups. There were no differences in HR,BP before induction with the two groups, and there were no statistic difference between groups in CVP,MAP,PVR,SVR,MPAP,PCWP, CI and BIS. CI increased in fentanyl group at 1 minute after OPCABG and at the end of operation, compared with after intubation; but CI increased in sufentanil group at 1 minute before OPCABG , at 1 minute after OPCABG and at the end of operation, compared with after intubation. PVR was reduced in fentanyl group at the end of...