Comparison of fentanyl, sufentanil, and alfentanil anesthesia in patients undergoing valvular heart surgery

The hemodynamic responses to anesthesia and surgery were studied in three groups of 20 patients undergoing valve replacement surgery. Anesthesia was induced with either fentanyl (75 micrograms/kg), sufentanil (15 micrograms/kg), or alfentanil (125 micrograms/kg). Pancuronium (8 mg) was given for muscle relaxation and the lungs were ventilated with oxygen/air (FIO2 = 0.5). Additional fentanyl (25 micrograms/kg) or sufentanil (5 micrograms/kg) was given before skin incision. Patients receiving alfentanil were given a continuous infusion at a rate of 0.5 mg X kg-1 X hr-1. Only mean arterial blood pressure (MABP) and systemic vascular resistance (SVR) changed significantly in response to anesthesia or surgery. MABP decreased on average 24.5 mm Hg (P less than 0.01) after induction of anesthesia with sufentanil in patients with mitral valve disease. MABP and SVR increased significantly (P less than 0.01) in patients with aortic valve disease receiving fentanyl. There were no other statistically significant changes within the groups. Four patients (two in the sufentanil group and one from each of the other groups) developed transient hypotension during induction of anesthesia. It is concluded that all three opioids can provide satisfactory anesthesia for patients having valve replacement surgery.