Anaesthesia for Patients With Coronary Artery Disease

Opioid Anaesthesia—fact or Fallacy?

“…This is more common in patients with coronary artery disease in whom hypertension, resulting in increased heart work and oxygen consumption, is potentially dangerous. These patients have limited ability to increase coronary artery blood flow and a large increase in arterial pressure can compromise their myocardial oxygen supply/demand balance (Waller and Kaplan, 1981). With doses of fentanyl 60-70ngkg" 1 there is a 45-50% frequency of hypertension greater than 20% of the pre-induction value (Sebel et al, 1982); increasing the dose to 125/igkg" 1 reduces the frequency to 10% (de Lange, Stanley and Boscoe, 1980).…”

“…While this may be true for the more severely ill patient, there is recent evidence to suggest that halothane increases coronary vascular reserve (Merin, 1980) and may thus be beneficial for the ischaemic heart. Waller and Kaplan (1981) recommended the use of inhalation drugs, which produce controllable myocardial depression, for patients with good left ventricular function undergoing coronary artery surgery, and the use of opioids for patients with diminished cardiac reserve. It is likely that the cardiac anaesthetist of the future may be more selective in his choice of anaesthetic technique based on improved pharmacological data.…”