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Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery.

Publication ,  Journal Article
Mark, JB; Horrow, JC; Eckenbrecht, PD; Smalky, M; Arthur, GR; Dhingra, U; Murray, E
Published in: J Cardiothorac Anesth
December 1987

In a randomized, double-blind trial, 59 patients undergoing coronary artery surgery received fentanyl 10, 15, or 25 microg/kg infused over 5 minutes for anesthetic induction. Half of the patients received intravenous lidocaine, 1.5 mg/kg, 1 minute before laryngoscopy. Efficacy of induction as judged by loss of consciousness was evaluated, and hemodynamic values during induction, laryngoscopy, and tracheal intubation were recorded each minute for 10 minutes. Plasma fentanyl concentrations were determined after termination of the fentanyl infusion. Opioid induction with fentanyl was successful in 90% (18 of 20) of patients receiving 25 microg/kg, 89% (17 of 19) of patients receiving 15 microg/kg, but only 55% (11 of 20) of patients receiving 10 microg/kg (P < .01). While plasma fentanyl concentrations were proportional to the dose infused (25 ng/mL, 18 ng/mL, and 14 ng/mL in the 25, 15. and 10 microg/kg fentanyl groups, respectively), there was no relationship between plasma fentanyl concentration and hemodynamic response to laryngoscopy or intubation. Opioid induction caused a gradual decrease in blood pressure that was restored with intubation. Lidocaine partially blocked this restoration (systolic blood pressure 122 +/- 5 v 138 +/- 5 mmHg, lidocaine v placebo, 1 minute after laryngoscopy, P < .05). Fentanyl, 15 or 25 microg/kg, intravenously, is an effective induction agent for patients with coronary artery disease. Supplementation with intravenous lidocaine, 1.5 mg/kg, will obtund the increase in blood pressure that occurs with laryngoscopy and intubation and help prevent infrequent hypertensive responses seen with this opioid technique.

Duke Scholars

Published In

J Cardiothorac Anesth

DOI

ISSN

0888-6296

Publication Date

December 1987

Volume

1

Issue

6

Start / End Page

517 / 523

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Lidocaine
  • Laryngoscopy
  • Humans
  • Heart Rate
  • Fentanyl
  • Female
  • Double-Blind Method
  • Coronary Artery Bypass
 

Citation

APA
Chicago
ICMJE
MLA
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Mark, J. B., Horrow, J. C., Eckenbrecht, P. D., Smalky, M., Arthur, G. R., Dhingra, U., & Murray, E. (1987). Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery. J Cardiothorac Anesth, 1(6), 517–523. https://doi.org/10.1016/0888-6296(87)90037-8
Mark, J. B., J. C. Horrow, P. D. Eckenbrecht, M. Smalky, G. R. Arthur, U. Dhingra, and E. Murray. “Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery.J Cardiothorac Anesth 1, no. 6 (December 1987): 517–23. https://doi.org/10.1016/0888-6296(87)90037-8.
Mark JB, Horrow JC, Eckenbrecht PD, Smalky M, Arthur GR, Dhingra U, et al. Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery. J Cardiothorac Anesth. 1987 Dec;1(6):517–23.
Mark, J. B., et al. “Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery.J Cardiothorac Anesth, vol. 1, no. 6, Dec. 1987, pp. 517–23. Pubmed, doi:10.1016/0888-6296(87)90037-8.
Mark JB, Horrow JC, Eckenbrecht PD, Smalky M, Arthur GR, Dhingra U, Murray E. Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery. J Cardiothorac Anesth. 1987 Dec;1(6):517–523.

Published In

J Cardiothorac Anesth

DOI

ISSN

0888-6296

Publication Date

December 1987

Volume

1

Issue

6

Start / End Page

517 / 523

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Lidocaine
  • Laryngoscopy
  • Humans
  • Heart Rate
  • Fentanyl
  • Female
  • Double-Blind Method
  • Coronary Artery Bypass