Comparison of sufentanil and fentanyl for surgical repair of congenital cardiac defects

Abstract

In the present study, the authors compared sufentanil to fentanyl in pediatric patients undergoing congenital cardiac repair. The purpose of the study was to evaluate the hemodynamic variables, time of awakening and successful extubation of the two groups. A prospective, randomized study of 60 children scheduled for elective surgery of congenital cardiac defects was made. Patients were randomly divided into two groups:- Group I; sufentanil and Group II; fentanyl (mean body weight, 16.02 ± 6.67 kg; range 4 to 35 kg; mean age, 5.22 ± 3.55 years; range 4 months to 1 year). All were premedicated with oral chloralhydrate 50 mg/kg, one hour preoperatively. Anesthesia was induced with sufentanil 1 μg/kg (Group I) or fentanyl 2 μg/kg (Group II) and thiopenthal 2 mg/kg, followed by atracurium 0.6 mg/kg. All patients were intubated with atracurium 0.6 mg/kg. Anesthesia was maintained using isoflurane in oxygen, nitrous oxide (in non-cyanotic patients). In Group I, sufentanil 0.5 μg/kg was administered intravenously prior to skin incision, median stemotomy, cardiopulmonary bypass (CPB) and after coming off CPB. In Group II, fentanyl 1 mg/kg was administered at the same time periods. Hemodynamic parameters, heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP), central venous pressure (CVP) were recorded. The administration of pain therapy was determined postoperatively. There was no statistical difference in the demographic data between the patients in the two groups. Following induction of anesthesia, the systolic, diastolic and mean arterial pressures and heart rate decreased. Following tracheal intubation, all hemodynamic parameters in the sufentanil group remained below the baseline values, while the fentanyl group showed an increase above baseline values. An increase above control values of all hemodynamic variables was detected in both groups following skin incision and sternotomy, except that the mean systolic blood pressure and heart rate in the sufentanil group was less than the baseline values. No differences in hemodynamic variables were detected between the two groups following median stemotomy and skin closure. There were significant differences in mean arterial pressure at the time of intubation and skin incision between the two groups. No significant changes in CVP occurred. There were no significant differences in the average time of awakening from anesthesia. The average time before postoperative tracheal extubation was 171.38 ± 112.74 and 113.72 ± 67.83 minutes in the sufentanil group and fentanyl group respectively, which was statistically significant. There was no difference in the requirements for morphine (pain relief) and sedation with chlolorahydrate between the groups. Bradycardia was found in 7 and 3 patients receiving sufentanil and fentanyl respectively which was not statistically significantly different. The bradycardia recovered in a few minutes, following intravenous injection of atropine. Slow injection of the anesthetic drugs can protect patients against serious bradycardia. In conclusion, the safety and efficacy of sufentanil in patients undergoing repair of complex congenital heart defects was the same as fentanyl. There were no significant differences in times of awakening in the two groups. The patients in sufentanyl group had a longer time to extubate than the fentanyl group. The need of postoperative sedation and analgesia was the same in both groups.