Fentanyl-induced hemodynamic changes after esophagectomy or cardiac surgery.

STUDY OBJECTIVE: The goal of this study was to characterize the hemodynamic response to propofol vs propofol with fentanyl when used for sedation after esophagectomy or cardiac surgery.

DESIGN: Prospective, randomized, controlled study.

SETTING: University Hospital, Intensive Care Unit.

PATIENTS: Thirty patients undergoing elective cardiac surgery and 26 patients undergoing esophagectomy were examined.

INTERVENTION: Patients were randomized to receive propofol (0.5 mg/kg bolus over 10 minutes, followed by continuous infusion at 1 mg/kg per hour) with or without fentanyl (2.0 microg/kg per hour) to achieve sedation overnight while in the intensive care unit. Randomization was performed in a double-blind manner.

MEASUREMENT: Mean arterial pressure (MAP) was monitored throughout the treatment period, and sedation level was measured. Sedation level was targeted to achieve a Ramsay score of 4.

MAIN RESULTS: The number of patients experiencing a greater than 20% drop in baseline MAP was higher in cardiac patients receiving propofol alone (11 of 15 patients, 73%) than in cardiac patients receiving propofol with fentanyl (4 of 15 patients, 27%). Furthermore, the time of optimal sedation was lower in the cardiac patients who received propofol than in cardiac patients who received propofol with fentanyl group (propofol alone, 79%; propofol with fentanyl, 88%). In contrast, there was no difference in the number of esophagectomy patients experiencing a greater than 20% drop in baseline MAP or in the mean time of optimal sedation when comparing the 2 treatment regimens.

CONCLUSIONS: Propofol has a differential effect on hemodynamics and sedation when comparing patients after cardiac surgery and esophagectomy.