ISSN: 2451-0629
Archives of Medical Science - Atherosclerotic Diseases
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Official journal of the International Lipid Expert Panel (ILEP)
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1/2020
vol. 5
 
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abstract:
Clinical research

Comparison of fentanil and remifentanil for coronary artery surgery with low ejection fraction

Nukhet Baddal
1
,
Cenk Conkbayir
2
,
Ozcan Erdemli
1
,
Umit Karadeniz
1
,
Busra Tezcan
1
,
Didem Melis Oztas
3
,
Metin Onur Beyaz
4
,
Murat Ugurlucan
4
,
Yahya Yildiz
5
,
Soner Yavas
1

1.
Department of Anaesthesiology, Yuksek Ihtisas Hospital, Ankara, Turkey
2.
Department of Cardiology, Near East University, Nicosia (north), Cyprus
3.
Department of Cardiovascular Surgery, Bagcilar Education and Research Hospital, Istanbul, Turkey
4.
Department of Cardiovascular Surgery, Medipol University Hospital, Istanbul, Turkey
5.
Department of Anaesthesia, Medipol University Hospital, Istanbul, Turkey
Arch Med Sci Atheroscler Dis 2020; 5: e20–26
Online publish date: 2020/03/06
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Introduction
In this study, we evaluated patient response and haemodynamic parameters in patients with low ejection fraction undergoing coronary bypass surgery with either fentanil or remifentanil in conjunction with etomidate.

Material and methods
We evaluated 30 cases of coronary artery surgery, which were divided into two treatment groups (n = 15 each). In group F (fentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate, and, following a 1 µg/kg 60 s bolus dose of fentanil, a 0.1 µg/kg/min fentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. In group R (remifentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate and, following a 1 µg/kg 60 s bolus dose of remifentanil, a 0.1 µg/kg/min remifentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. Systolic artery pressure, diastolic artery pressure, mean arterial pressure, heart rate, SPO2 (saturation), cardiac output, stroke volume variance, central venous pressure, and systemic vascular resistance values were recorded for all study patients at five minutes before anaesthetic induction (T1), immediately following induction (T2), and immediately following intubation (T3).

Results
The demographic values obtained for both groups were similar. We found that remifentanil use was associated with decreased cardiac output and increased fluctuations in both heart rate and mean values of arterial pressure.

Conclusions
Although many studies have demonstrated remifentanil to be as safe as fentanil when titrated to an appropriate dose, our study suggests that fentanil may be a more appropriate choice during the induction of anaesthesia in patients with a low ejection fraction.

keywords:

low ejection fraction, coronary artery bypass surgery, anaesthesia

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