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Diazepam-Fentanyl Interaction-Hemodynamic and Hormonal Effects in Coronary Artery Surgery

Received from the Anesthesia Service of the Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary, and the Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.

Abstract

Diazepam has been reported to produce hypotension when administered with anesthetic doses offentanyl. Twenty patients undergoing coronary bypass surgery were randomly assigned to one of four treatment groups: group 1, no diazepam; groups 2, 3, and 4, 0.125, 0.25, and 0.5 mg·kg^–1 of diazepam, respectively. All patients then received 50 µg·kg^–1 fentanyl at 400 µg·min^–1 and 0.4 mg·kg^–1 metocurine at 2 mg·min^–1. Hemodynamic parameters were recorded and blood was sampled for measurement of plasma catecholamine and histamine concentrations. Heart rate, cardiac index, stroke volume index, central venous pressure, pulmonary arterial and wedge pressures, and pulmonary vascular resistance did not change significantly in any group. Patients in groups 2–4 had significant decreases in mean arterial pressure and systemic vascular resistance during fentanyl infusion. These hemodynamic changes were accompanied by decreases in plasma epinephrine and norepinephrine levels. These hemodynamic and hormonal changes did not occur in patients given fentanyl only. Plasma histamine levels did not change significantly in any group. Caution should be used when diazepam in doses as small as 0.125 mg·kg^–1 are combined with high-dose fentanyl anesthesia.

Key Words: INTERACTIONS: diazepam, fentanyl • ANALGESICS, fentanyl • HYPNOTICS, Benzodiazepines: diazepam • HISTAMINE

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999