Intrathecal sufentanil for coronary artery bypass grafting

Context: Cardiac surgery patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Objective: Evaluate the effect of adding intrathecal sufentanil to general anesthesia on hemodynamics.

Design: Prospective, randomized, not blinded study, after approval by local ethics in Research Committee.

Setting: Monocentric study performed at Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.

Patients: 40 consenting patients undergoing elective coronary artery bypass, both genders.

Exclusion criteria: Chronic kidney disease; emergency procedures; reoperations; contraindication to spinal block; left ventricular ejection fraction less than 40%; body mass index above 32kg/m(2) and use of nitroglycerin.

Interventions: Patients were randomly assigned to receive intrathecal sufentanil 1μg/kg or not. Anesthesia induced and maintained with sevoflurane and continuous infusion of remifentanil.

Main outcome measures: Hemodynamic variables, blood levels of cardiac troponin I, B-type natriuretic peptide, interleukin-6 and tumor necrosis factor alfa during and after surgery.

Results: Patients 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.

Conclusions: Patients receiving intrathecal sufentanil have more hemodynamical stability, as suggested by the reduced inotropic support and fewer adjustments in intravenous opioid doses.