Comparision The Effects Of Fentanyl And Sufentanil In Anesthesia Of Off-pump Corynary Artery Bypass Surgery

Objective: To compare anesthetic effect of fentanyl and sufentanil on off-pump coronary artery bypass graft and to provide reference for reasonable selection of narcotic analgesic.Methods: Forty cases of ASA grade Ⅱ～Ⅲ patients for selective off-pump coronary artery bypass graft (OPCABG) were randomly divided into two groups: sufentanil group (group S) and fentanyl group (group F). For each group, such items are observed as the mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), system vascular resistance (SVR), pulmonary vascular resistance (PVR), mean pulmonary arterial blood pressure (MPAP), pulmonary capillary wedge pressure (PCWP), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), dosage of propofol through the surgery, application of vasoactive drugs and the duration of analepsia and extubation after surgery. All the items are observed at ten points: the time before anesthesia induction (T₀), 2 min after anesthesia induction and before tracheal intubation (T₁), 1 min after tracheal intubation (T₂), 5 min after tracheal intubation (T₃), 10 min after tracheal intubation (T₄), the time of skin discission (T₅), the time of sternum split (T₆), the time of surgery finished (T₇), the time of analepsia (T₈) and the time of extubation (T₉). Results: MAP, HR and SVR decrease dramatically at T₁ compared to T₀ in both sufentanil group and fentanyl group (P<0.01), but there are no difference between two groups (P>0.05). After tracheal intubation and extubation, MAP, HR and SVR all increase in both sufentanil group and fentanyl group, HR at T2,T3,T4,T7,T8,T9 , SVR at T2,T3, T9 and MAP at T2,T9 sufentanil group are much lower than fentanyl group (P<0.01 or P<0.05). From T₂ to T₆, there is no obvious difference of CI in sufentanil group, but it decrease dramatically in fentanyl group (P<0.01 or P<0.05). On the other hand, during this period, SVI is much higher in sufentanil group than in fentanyl group (P<0.01). The difference in haemodynamics is of no statistical significance between T₅, T₆ and T₇. The propofol dosage in sufentanil group is much lower than fentanyl group (P<0.05), but there is no difference in application of vasoactive drugs. The S-T segment in electrocardiogram do not change much during the surgery. The duration of analepsia and extubation are much shorter in sufentanil group than fentanyl group (P<0.05) and the toleration of patients during analepsia is much better in sufentanil group than in fentanyl group.Conclusion: Both sufentanil and fentanyl can be used to off-pump coronary artery bypass graft safely. But the equivalent dosage of sufentanil, when compared to fentanyl, can bring more stability in haemodynamics, stronger analgesic effect, lighter respiratory depression, earlier analepsia and extubation.