Abstract:
Objective: To compare the effects of different dosages of fentanyl combined with propofol on plasma cardiac troponin-I(cTn-I) and management of fast track cardiac anesthesia(FTCA) in patients undergoing open heart surgery with cardiopulmonary bypass(CPB).
Methods: Thirty patients,scheduled for undergoing atrioseptopexy or ventriseptopexy were randomly divided into three fentanyl dosage groups,ten patients each group.Fentanyl of 15 μg/kg was administered in group A,30 μg/kg in group B and 50 μg/kg in group C.Three groups were combined with intravenous infusion of propofol 2 to 4 mg·kg
-1·h
-1.The radial artery blood samples were collected to measure the plasma concentration of cTn-I before operation(T
1),at the onset of aorta unclamping(T
2),30 min after aorta unclamping(T
3),4 h after weaning from CPB(T
4) and 24 h after weaning from CPB(T
5).ECG,HR,BP,CVP,SpO
2,PETCO
2,and body temperature(naso-pharyngeal and rectal) were continuously monitored during operation.Time of emergence from anesthesia and exlubation and the duration of stay in ICU were recorded.
Results: The plasma concentration of cTn-I was increased significantly in three groups at T
3,T
4 and T
5 compared with those at(T
1)(P<0.01) and reached the peak level at T
4 then was decreased at T
5.cTn-I values in group B.Group C were lower than those in group A(P<0.01).There were no significant differences between group B and C(P>0.05).Time of emergence from anesthesia were significantly shorter in group A than in group B and C(P<0.05).Time of extubation were significantly shorter in group A and B than in group C(P<0.01 and P<0.05).The duration of stay in ICU showed a tendency of increase but there were no significant differences in three groups(P>0.05).
Conclusions: Fentanyl 30 μg/kg combined with propofol 2 to 4 mg·kg
-1·h
-1 is suitable for protecting the myocardium from reperfusion injury and managemant of FTCA.