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 sufentanit 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 32 kg/m(2) and use of nitroglycerin. Interventions: Patients were randomly assigned to receive intrathecal sufentanil 1 mu g/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, interteukin-6 and tumor necrosis factor alfa during and after surgery. Results: Patients in sufentanit 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 sufentanit have more hemodynamical stability, as suggested by the reduced inotropic support and fewer adjustments in intravenous opioid doses. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.