Objective: General anesthesia management in coronary artery bypass graft surgery (CABGC) should preserve myocardial function, prevent ischemic damage, and maintain stable hemodynamic response. There is not an universally accepted technique for anesthetic management during CABGC. Drugs or drug combinations and maintenance of infusions are decided based on the pathophysiological condition of the patient and the individual preference and experience of the anesthesiologist. Although there are many studies about an anesthesia induction in CABGC, studies about anesthetic maintenance are very limited. In this study, we compared the hemodynamic effects of three different methods that were used in anesthetic maintenance in CABGC.
Material and Methods:
Retrospectively 108 patients records in ASA II-III group who underwent elective CABGC were divided into 3 groups according to their anesthetic maintenance methods. Group I was maintained with 1-3% sevoflurane and fentanyl 4 mcg/kg/hour infusion, Group II with propofol 1.5-4 mg/kg/hour and fentanyl 4 mcg/kg/hour infusion, and Group III with propofol 1.5-4 mg/kg/hour and remifentanil infusion of 0.03 mg/kg/hour. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured and recorded after induction (T0), sternotomy (T1), pericardiotomy (T2), 5 minutes after cardiopulmonary bypass (CPB) (T3), thorax closure (T4), and at the end of the operation (T5). The vasodilator requirements in the time period before CBP and the inotropic agent requirements after CPB were noted.
Results: Data of 108 patients (88 men/20 women) were analyzed. Demographic characteristics were similar in all the groups. Statistical analysis was made between the groups depending on coronary artery bypass graft number, cross-clamp time, total fluid administration, total blood transfusion, total urine volume, inotropic agent requirements after CPB, postoperative central venous pressure (CVP), and pre- and postoperative lactate levels. However, there was no statistical difference. There was not more than a 20-25% change in MAP and HR in Group I than in the others.
Conclusion: Better hemodynamic results were achieved with sevoflurane and fentanyl in the anesthetic maintenance of CABGC.
Key words: Cardiovascular anesthesia, inhalation, intravenous, hemodynamics
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