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 microg/kg (Group I) or
fentanyl 2 microg/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 microg/kg was administered intravenously prior to skin incision,
median sternotomy,
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 sternotomy 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.