Intrathecal sufentanil for coronary artery bypass grafting

ContextCardiac surgery patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.ObjectiveEvaluate the effect of adding intrathecal sufentanil to general anesthesia on hemodynamics.DesignProspective, randomized, not blinded study, after approval by local ethics in Research Committee.SettingMonocentric study performed at Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.Patients40 consenting patients undergoing elective coronary artery bypass, both genders.Exclusion criteriaChronic kidney disease; emergency procedures; reoperations; contraindication to spinal block; left ventricular ejection fraction less than 40%; body mass index above 32 kg/m2 and use of nitroglycerin.InterventionsPatients were randomly assigned to receive intrathecal sufentanil 1 μg/kg or not. Anesthesia induced and maintained with sevoflurane and continuous infusion of remifentanil.Main outcome measuresHemodynamic variables, blood levels of cardiac troponin I, B-type natriuretic peptide, interleukin-6 and tumor necrosis factor alfa during and after surgery.ResultsPatients in sufentanil group required less inotropic support with dopamine when compared to control group (9.5% vs 58%, p = 0.001) and less increases in remifentanil doses (62% vs 100%, p = 0.004). Hemodynamic data at eight different time points and biochemical data showed no differences between groups.ConclusionsPatients receiving intrathecal sufentanil have more hemodynamical stability, as suggested by the reduced inotropic support and fewer adjustments in intravenous opioid doses.