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  • Title: Fentanyl-induced hemodynamic changes after esophagectomy or cardiac surgery.
    Author: Kadoi Y, Hinohara H, Kunimoto F, Saito S, Goto F.
    Journal: J Clin Anesth; 2005 Dec; 17(8):598-603. PubMed ID: 16427529.
    Abstract:
    STUDY OBJECTIVE: The goal of this study was to characterize the hemodynamic response to propofol vs propofol with fentanyl when used for sedation after esophagectomy or cardiac surgery. DESIGN: Prospective, randomized, controlled study. SETTING: University Hospital, Intensive Care Unit. PATIENTS: Thirty patients undergoing elective cardiac surgery and 26 patients undergoing esophagectomy were examined. INTERVENTION: Patients were randomized to receive propofol (0.5 mg/kg bolus over 10 minutes, followed by continuous infusion at 1 mg/kg per hour) with or without fentanyl (2.0 microg/kg per hour) to achieve sedation overnight while in the intensive care unit. Randomization was performed in a double-blind manner. MEASUREMENT: Mean arterial pressure (MAP) was monitored throughout the treatment period, and sedation level was measured. Sedation level was targeted to achieve a Ramsay score of 4. MAIN RESULTS: The number of patients experiencing a greater than 20% drop in baseline MAP was higher in cardiac patients receiving propofol alone (11 of 15 patients, 73%) than in cardiac patients receiving propofol with fentanyl (4 of 15 patients, 27%). Furthermore, the time of optimal sedation was lower in the cardiac patients who received propofol than in cardiac patients who received propofol with fentanyl group (propofol alone, 79%; propofol with fentanyl, 88%). In contrast, there was no difference in the number of esophagectomy patients experiencing a greater than 20% drop in baseline MAP or in the mean time of optimal sedation when comparing the 2 treatment regimens. CONCLUSIONS: Propofol has a differential effect on hemodynamics and sedation when comparing patients after cardiac surgery and esophagectomy.
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