Effects of different dosages of fentanyl on plasma cardiac troponin-I and management of fast track cardiac anesthesia in patients undergoing open heart surgery

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(T₁),at the onset of aorta unclamping(T₂),30 min after aorta unclamping(T₃),4 h after weaning from CPB(T₄) and 24 h after weaning from CPB(T₅).ECG,HR,BP,CVP,SpO₂,PETCO₂,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 T₃,T₄ and T₅ compared with those at(T₁)(P<0.01) and reached the peak level at T₄ then was decreased at T₅.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.