Propofol -fentanyl anaesthesia: a comparison with isoflurane-fentanyl anaesthesia in coronary artery bypass graft surgery.

ABSTRACT

The haemodynamic effects of propofol -fentanyl anaesthesia (n=25) were compared with isoflurane-fentanyl anaesthesia (n=25) in patients with normal left ventricular ejection fraction (>45%) undergoing coronary artery bypass graft surgery under cardiopulmonary bypass. In the propofol group (Group P), anaesthesia was induced with midoazolam 2.5 to 5.0 mg, fentanyl 5mg/kg, pancuronium 0.1 mg/kg and propofol 1-2 mg/kg and was maintained with propofol infusion 10 mg/kg/hr till sternotomy, followed by 3 mg/kg/hr till skin closure. In the inhalational group (Group I) anaesthesia was induced with midazolam, fentanyl, pancuronium in the same doses and sleep dose of thiopentone and was maintained with oxygen nitrous oxide (5050) and isoflurane (0.5-1%). Additional fentanyl 2.5 microg/kg was given before sternotomy. Haemodynamic measurements were made before induction, after induction, after sternotomy, after heparinisation, after release of aortic cross clamp, post-bypass, post-sternal closure and on arrival in the recovery room. Post-bypass the cardiac index was higher in Group P (2.90+/- 0.76 v/s 2.40 +/- 0.40, p <0.05). Similarly post-bypass stroke volume index was higher in Group P (379.32 +/- 6.31 v/s 26.78 +/- 6.24, p<0.05). Patients in Group P were extubated earlier as compared to Group I (379.50 +/- 69 min v/s 453.00 +/- 134 min, p<0.05). This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with normal left ventricular ejection fraction undergoing coronary artery bypass graft surgery.