A comparison of the myocardial metabolic and haemodynamic changes produced by propofol-sufentanil and enflurane-sufentanil anaesthesia for patients having coronary artery bypass graft surgery

The purpose of this study was to compare propofol-sufentanil with enflurane-sufentanil anaesthesia for patients undergoing elective coronary artery bypass graft (CABG) surgery with respect to changes in (1) haemodynamic variables; (2) myocardial blood flow and metabolism; (3) serum cortisol, triglyceride, lipoprotein concentrations and liver function; and (4) recovery characteristics. Forty-seven patients with preserved ventricular function (ejection fraction > 40%, left ventricular enddiastolic pressure ≤ 16 mmHg) were studied. Patients in Group A (n = 24) received sufentanil 0.2 μg · kg^{- 1} and propofol 1- 2 mg · kg^{- 1} for induction of anaesthesia which was maintained with a variable rate propofol (50-200 μg · kg^{- 1} · min^{- 1}) infusion and supplemental sufentanil (maximum total 5 μg · kg^{- 1}). Patients in Group B (n = 23) received sufentanil 5 μg · kg^{- 1} for induction of anaesthesia which was maintained with enflurane and supplemental sufentanil (maximum total 7 μg · kg^{- 1}). Haemodynamic and myocardial metabolic profiles were determined at the awake-sedated, post-induction, post-intubation, first skin incision, post-sternotomy, and pre-cardiopulmonary bypass intervals. Induction of anaesthesia produced a larger reduction in systolic blood pressure in Group A (156 ± 22 to 104 ± 20 mmHg vs 152 ± 26 to 124 ± 24 mmHg; P < 0.05). No statistical differences were detected at any other time or in any other variable including myocardial lactate production (n = 13 events in each group), time to tracheal extubation and time to discharge from the ICU. We concluded that, apart from hypotension on induction of anaesthesia, propofol-sufentanil anaesthesia produced anaesthetic conditions equivalent to enflurane-sufentanil anaesthesia for CABG surgery.