Sufentanil blunts the myocardial stress induced by tracheal intubation in older adult patients with coronary heart disease better than equipotent fentanyl

BACKGROUND: To evaluate the role of sufentanil and fentanyl in the prevention of cardiovascular responses to endotracheal intubation in elderly patients with coronary heart disease (CHD). METHODS: Seventy-one CHD patients scheduled for surgery under general anesthesia were randomly divided into two groups to receive either 0.4 µg/kg of sufentanil (n=35) or 4 µg/kg of fentanyl (n=36) in a double-blind manner. Under local anesthesia, an invasive arterial catheter is used to monitor systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP). Laryngoscopy and tracheal intubation were successfully performed within 30 seconds. MAP and heart rate (HR) were recorded before anesthesia induction, immediately before intubation, at intubation, and 1, 3, 5 min after tracheal intubation. Rate pressure product (RPP) is calculated by SBP multiple HR. RESULTS: Patients in the fentanyl group showed a significant increase in MAP, HR, and RPP associated with tracheal intubation. However, the cardiovascular stimulation induced by tracheal intubation was attenuated in the sufentanil group. CONCLUSIONS: Laryngoscope and endotracheal intubation may cause adverse increases in blood pressure (BP) and HR in elderly patients with CHD, resulting in an imbalance of myocardial oxygen consumption and supply and myocardial ischemia. Anesthesia induction with sufentanil 0.4 µg/kg is more potential than fentanyl 4 µg/kg to attenuate the cardiovascular intubation response.