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Michael C. Damask, MD; Charles Weissman, MD; Jeffrey Askanazi, MD; Stanley H. Rosenbaum, MD; David Elwyn, PhD; Allen I. Hyman, MD

Arch Surg. 1987;122(9):1026-1031.

Abstract
• This study examines the oxygen consumption (Vo₂) and carbon dioxide production (Vco₂) occurring before, during, and after cardiopulmonary bypass (CPB) and whether they correlate with changes in cardiac output. Twenty-three patients undergoing open heart surgery were studied. Group 1 (N =11) received fentanyl citrate, 50 µg/kg, intravenously during the induction of anesthesia. Group 2 (N=12) received 100 µg/kg of fentanyl citrate intravenously. We measured Vo₂, Vco₂, as well as hemodynamic and biochemical factors. Initial statistical analyses failed to show any differences in the Vo₂, Vco₂, hemodynamic, or biochemical factors between groups 1 and 2. Therefore, the data from both groups were combined. In comparing the average (for all data) of the post-CPB with the pre-CPB periods in both groups for the metabolic factors, there were 9.0%, 11.5%, and 2.4% increases in the Vo₂, Vco₂, and respiratory quotient, respectively. There was an 80% increase in total serum lactate levels seen in the post-CPB periods when compared with the pre-CPB periods. Serum triglyceride and free fatty acid levels measured in the post-CPB period decreased 39% and 25%, respectively, when compared with the pre-CPB periods. Although there were no changes in the cardiac outputs following CPB, the post-CPB periods showed a 37% increase in central venous pressure when compared with the pre-CPB periods. These data suggest that although there are significant metabolic and biochemical sequelae to CPB, the modest increases in post-CPB Vo₂, and Vco₂ did not affect cardiac output following cardiovascular surgery. Increasing doses of narcotic do not have an effect on those relationships.

(Arch Surg 1987;122:1026-1031)

Author Affiliations
From the Departments of Anesthesiology (Drs Damask, Weissman, Askanazi, Rosenbaum, and Hyman), Medicine (Drs Weissman and Rosenbaum), and Surgery (Dr Elwyn), College of Physicians and Surgeons, Columbia University, New York.

Footnotes
Accepted for publication July 18, 1986.

Reprint requests to Department of Anesthesiology, Columbia University, 630 W 168th St, New York, NY 10032 (Dr Damask).

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