Isoflurane versus fentanyl: Hemodynamic effects in cancer patients treated with anthracyclines Journal Article

  


Authors: Thorne, A. C.; Orazem, J. P.; Shah, N. K.; Matarazzo, D.; Dwyer, D.; Pierri, M. K.; Hoskins, W. J.; Rubin, S. C.; Bedford, R. F.
Article Title: Isoflurane versus fentanyl: Hemodynamic effects in cancer patients treated with anthracyclines
Abstract: Cancer patients treated with anthracycline derivatives are at risk for perioperative cardiovascular decompensation. The authors studied hemodynamic performance before, during, and after laparotomy in 14 anthracycline-treated patients with ovarian carcinoma. General anesthesia was maintained with 70% N2O in O2, and patients were randomized to receive supplementation with either isoflurane, 0.59% end-tidal ± 0.04 (mean ± SE), or fentanyl, 2.67 μg/ kg ± 0.49 as a loading dose, and a total dose of 7.16 μg/kg ± 0.71. The degree of hemodynamic stability relative to the baseline was assessed. There was no obvious superiority of either technique prior to the skin incision. However, during and immediately after surgery, a clearer tendency for isoflurane-N2O to result in better hemodynamic stability was found. lsoflurane-N2O demonstrated significantly smaller change scores in systemic vascular resistance (SVR) and cardiac index (Cl). At the start of surgery, the isoflurane-N2O change in SVR was 228.08 dyne · sec · cm-5 compared to 479.58 for the fentanyl patients, (P = 0.002); at the end of surgery the corresponding means were -12.09 and 703.14 dyne · sec · cm-5, respectively, (P = 0.002). Isoflurane-N2O was associated with significantly greater CI stability in the early postoperative period: the isoflurane-N2O mean change was -0.081 L/min/m2, versus -0.993 for the fentanyl-N2O patients, (P = 0.005). The authors conclude that anthracycline-treated patients who do not have overt evidence of cardiomyopathy can be safely anesthetized with either anesthetic technique. However, during surgery and in the early postoperative period, an isoflurane-N2O technique appears to offer better hemodynamic stability. © 1993.
Keywords: adult; clinical article; postoperative period; chemotherapy; laparotomy; ovarian neoplasms; ovary cancer; risk factors; time factors; intraoperative period; general anesthesia; blood pressure; anthracycline derivative; anthracyclines; electrocardiography; heart index; cardiac output; stroke volume; hemodynamics; cardiomyopathy; ventricular function, left; fentanyl; mean arterial pressure; pulmonary artery; middle age; isoflurane; heart rate; nitrous oxide; systemic vascular resistance; anesthesia, intravenous; human; female; priority journal; article; anesthesia, inhalation; inhalational drug administration; anesthetic techniques; antibiotics, anthracycline; cardiovascular complications; acid-base imbalance; atrial function, right; pulmonary wedge pressure; vascular resistance
Journal Title: Journal of Cardiothoracic and Vascular Anesthesia
Volume: 7
Issue: 3
ISSN: 1053-0770
Publisher: Elsevier Inc.  
Date Published: 1993-06-01
Start Page: 307
End Page: 311
Language: English
DOI: 10.1016/1053-0770(93)90010-i
PUBMED: 8518377
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-0027319580&doi=10.1016%2f1053-0770%2893%2990010-I&partnerID=40&md5=fed6d1a4b7c4891e4df4b4c25ac84ef0
Notes: Article -- Export Date: 1 March 2019 -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Alisa C Thorne
    16 Thorne
  2. William Hoskins
    255 Hoskins
  3. Mary Kathryn M Pierri
    16 Pierri
  4. Stephen C. Rubin
    112 Rubin
  5. Deborah Anne Matarazzo
    3 Matarazzo
  6. Robert F. Bedford
    39 Bedford
  7. John Orazem
    11 Orazem
Related MSK Work