Mary Tina Rani Vaz, G (2012) High dose Fentanyl versus Multi-agent Combination Technique for Induction of Anaesthesia in patients coming for Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial. Masters thesis, Christian Medical College, Vellore.
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Abstract
PURPOSE: When administering an anaesthetic to a cardiac patient, there are certain haemodynamic goals to be achieved . These are to reduce and control those factors that increase myocardial oxygen demand and also to optimize coronary blood flow. A smooth transition from consciousness to sleep is desired, without untoward airway difficulties or haemodynamic responses. Deep planes of anaesthesia, brief duration of laryngoscopy, and innumerable pharmacological regimens have been proposed for the elimination of the hypotension that follows induction of anaesthesia and the hypertension and tachycardia associated with intubation of the trachea. We compared two regimens- the widely used Multi-agent combination technique, and the High dose Fentanyl technique to ascertain which provided better haemodynamic stability. MATERIAL AND METHODS: In this randomized controlled trial, 70 patients admitted for elective coronary artery bypass graft surgery were randomized into 2 groups of 35 each. Baseline haemodynamic parameters including heart rate, systolic, diastolic and mean blood pressures and oxygen saturation were taken. Patients randomized into the Multi-agent group were induced with 5μ/kg Fentanyl, 0.05mg/kg Midazolam and 2-6% Sevoflurane. Patients in the High dose Fentanyl group were induced with 50μ/kg Fentanyl. Haemodynamic parameters and oxygen saturation were recorded every minute for 6 minutes of induction. The patients were intubated at the 6th minuate and the last reading was taken 30 seconds after intubation. The number of vasopressor boluses (Ephedrine and Phenylephrine) administered during this time was also recorded. Ease of bag and mask ventilation was noted subjectively. RESULTS: This study showed that the mean heart rates were significantly lower in the Multi-agent group when compared to the High dose Fentanyl group, from the fourth minute of the six minute induction period, till 30 seconds post-intubation (p- values <0.05). Similarly, systolic, diastolic and mean blood pressure readings were significantly lower in the Multi-agent group when compared to the High dose Fentanyl group. This difference is seen from the second minute of induction till one minute post-intubation (p- values< 0.05). Our results also showed that 28 patients required Ephedrine boluses in the Multi-agent group, when compared to nil boluses administered in the High dose Fentanyl group. Similarly 29 patients required Phenylephrine boluses in the Multi-agent group, while only one patient required it in the High dose Fentanyl group. These differences were statistically significant with p- values of 0.006 and 0.000, respectively. CONCLUSION: From this we can conclude that a significant number of patients in the Multi-agent group required vasopressor support to maintain adequate blood pressures in the induction period. Incidence of chest wall rigidity was not significant as measured by a subjective difficulty in bag and mask ventilation (p-value = 0.246) and drop in saturation (all p-values >0.05).
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | High dose fentanyl, Coronary artery disease, Haemodynamics, Midazolam, Sevoflurane. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Sep 2020 04:07 |
| Last Modified: | 14 Sep 2020 08:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13131 |
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