[Brain function and level of consciousness in fentanyl anesthesia in heart surgery]

Abstract

The level of consciousness and the supply/demand ratio of oxygen in the brain was studied in anaesthetized patients undergoing open heart surgery. Anaesthesia was accomplished with intravenous fentanyl; 26 patients received 25 micrograms/kg and 24 patients received 50 micrograms/kg fentanyl. In addition only pancuronium bromide was administered for muscular relaxation; all patients were ventilated with 100% oxygen. The following measurements were made during induction and prior to cardiopulmonary bypass and in the first ten minutes of bypass: 1. EEG with the Klein EEG Analyzer. This instrument permits simultaneous analysis of frequency and amplitude while eliminating muscular artifacts. 2. Cerebral oxygen with the Niroscope. This instrument uses an infrared light beam through the brain to evaluate cerebral oxygen sufficiency. 3. Oxygen supply/demand ratio in the whole body, estimated from mixed venous oxygen saturation measured with a fiberoptic pulmonary artery catheter. Clinical unconsciousness occurred in all patients within about 30 s after the administration of fentanyl. Simultaneously the EEG showed a significant decrease in frequency and an increase in amplitude. With the Niroscope no change in oxygen supply and demand was seen in any patients. This is in contrast to previous studies with thiopental, where changes were seen. A slight increase in mixed venous oxygen saturation was observed. This indicates an increase in the total oxygen supply/demand ratio, probably due to decreased muscle metabolism induced by pancuronium bromide paralysis. From the end of induction until cardiopulmonary bypass a slight increase in cerebral electrical activity was observed; an additional increase occurred in the first ten minutes of bypass.(ABSTRACT TRUNCATED AT 250 WORDS)