The Hemodynamic Effects of Sevoflurane and Fentanyl in Elderly Patients with Hypertension

Lee, Guie Yong; Kim, Chi Hyo; Lim, Eui Seung

Abstract

BACKGROUND: The hemodynamic effects of sevoflurane in elderly patients with hypertension are unknown. This study was conducted to evaluate the hemodynamic responses to sevoflurane and fentanyl in elderly patients, either with or without hypertension.
METHODS
With their informed consent, 30 elderly patients (> 65 yrs), undergoing elective surgery, were divided into those with (n = 15, Group H) and those without (n = 15, Group N) chronic hypertension. Anesthesia was induced with a 1.5 mg/kg bolus of propofol, and 0.1 mg/kg vecuronium. Following tracheal intubation, 50% N2O in oxygen was initiated with the insertion of a transesophageal Doppler device for cardiac output monitoring (HemoSonic(TM)), into 10 and 7 patients of Groups H and N, respectively. After the mean arterial pressure (MAP) had returned to the preanesthetic level, sevoflurane was titrated to maintain the end tidal concentration (FET) 1 minimum alveolar concentration (MAC). The MAP, heart rate (HR), cardiac index (CI) and systemic vascular resistance (SVR) were successively recorded during the administrations of N2O only, N2O and FET sevoflurane 1 MAC, as well as N2O and FET sevoflurane 1 MAC plus fentanyl (1microgram//kg). The MAC of the sevoflurane was adjusted in relation to age. Statistical significances (P<0.05) were assessed using paired t, unpaired t, Mann-Whitney, Friedman and Wilcoxon Signed rank tests.
RESULTS
With a FET sevoflurane 1 MAC, the addition of fentanyl to Groups H and N caused significant decreases in the MAP, HR and CI. There were no significant differences between the two groups.
CONCLUSIONS
No significant hemodynamic differences to sevoflurane and fentanyl were observed between hypertensive and normotensive elderly patients. Sevoflurane and fentanyl caused decreases in the hemodynamic responses in both hypertensive and normotensive elderly patients.