Atropine Effects in Anaesthesia With Sufentanil vs. Remifentanil
Status:
Unknown status
Trial end date:
2014-06-01
Target enrollment:
Participant gender:
Summary
Induction of general anaesthesia with a combination of opiates and hypnotics often induces
vasodilation resulting in several haemodynamic effects such as a decrease in blood pressure
(MAP), heart rate (HR) and cardiac output (CO). This haemodynamic suppression may jeopardize
tissue oxygenation, particularly cerebral oxygenation. Previous research of the investigators
group has revealed that atropine has an exceptionally beneficial effect on the determinants
of tissue oxygen delivery as well as on tissue oxygenation. The investigators have
demonstrated a significant and clinically relevant increase in CO and cerebral tissue
oxygenation (SctO2) for a desired increase in MAP. This is in steep contrast with the more
usual clinical practice of administrating classical vasoactive medication such as
phenylephrine or norepinephrine, since the two latter have an even negative effect on CO and
SctO2. In previous research the investigators used standardized target controlled
propofol/remifentanil infusions for induction and maintenance of anaesthesia. It is known
that remifentanil has more intense haemodynamic side-effects compared to other opiates such
as fentanyl, sufentanil or alfentanil. This raises the question whether the beneficial effect
of atropine is restricted to propofol/remifentanil anaesthesia, or if this is equally valid
during anaesthesia of propofol combined with other opiates such as sufentanil.
Patients undergoing off-pump coronary artery bypass grafting (CABG) require a long and deep
general anaesthesia, which is usually performed with the combination of drugs as mentioned
above. Because these patients often experience severe haemodynamic fluctuations they need to
be closely monitored.