The usage of personalized scheme of fentanyl administration during coronary artery stenting

Abstract

The aim – to develop a personalized scheme of fentanyl administrationfor coronary artery stenting. Materials and methods. Ninety patients with ischemic heart disease who underwent planned stenting of the coronary arteries were studied. The patients who underwent surgery were evenly divided into three study groups, depending on mode of the intraoperative analgesic sedation and the approaches to anesthesia. The first comparison group consisted of patients who received slow intravenous administration of diazepam and fentanyl solutions. The second comparison group consisted of patients with balanced administration of fentanyl and propofol solutions to provide analgesic sedation at the level of conscious anesthesia. The study group consisted of patients with a personalized approach to the administration of opiates, namely, we used the original fentanyl test described in the article. Analgesic sedation at the level of conscious anesthesia (ІІІ by Ramsey) was maintained by propofol infusion. Results. The usage of a personalized scheme of fentanyl administration for stenting of the coronary arteries, compared to the standard sedation using combination of diazepam and fentanyl, was accompanied by better indicators of intraoperative blood saturation with oxygen and carbon dioxide (respectively (103.67 ± 22.05) and (39.64 ± 6.85) mm Hg in group 1, (105.70 ± 31.64) and (37.68 ± 7.11) in group 2 and (109.42 ± 34.36) and (36.25 ± 6.52) mm Hg in patients of the 3rd group), lower blood pressure after surgery ((127.85 ± 9.87)/(79.64 ± 8.62) mm Hg in patients of group 1, (129.48 ± 8.73)/(81.05 ± 7.92) mm Hg in group 2 and (131.15 ± 10.64)/(82.68 ± 9.72) mm Hg in group 3), lower level of stress markers (blood cortisol during surgery in patients of the 1st group (8.83 ± 4.58) mmol/L, in patients of the 2nd group – (7.73 ± 2.79) mmol/L, in patients of the 3rd group – (7.55 ± 4.35) mmol/L), as well as lower frequency of detecting episodes of perioperative pain of various origins. Conclusions. A method of personalized anesthesia was elaborated, based on individual scheme of fentanyl administration («fentanyl test») during coronary artery stenting. Its usage is safe (due to the optimal parameters of gas exchange and hemodynamics and fewer side effects, such as nausea and residual sedation) and effective (due to the lower level of stress markers and less frequent complaints of pain of various origins) than when the routine technique was used.

Keywords

• analgesic sedation
• individual sensitivity
• fentanyl
• diazepam
• propofol