&NA;Thirty consecutive patients with angiographically demonstrated coronary artery disease randomly received anesthesia either with morphine, diazepam, nitrous oxide in oxygen, and pancuronium (group 1—16 patients), or with ketamine, nitrous oxide in oxygen, and pancuronium (group 2—14 patients). The incidence of intraoperative complications was the same in both groups: hypertension occurred in nine patients of group 1 and six in group 2; ventricular arrhythmias, two in group 1 and one in group 2; death, one in each group. Incidence of postoperative complications was also similar. Although theincidenceof hemodynamic changes was similar, thedegreeof maximal change in systolic blood pressure differed between groups. The mean maximal increase in systolic BP was significantly greater in group 2 (33% of control) than group 1 (16%). The maximal decrease in systolic BP was significantly greater in group 1 (18% of control) than group 2, and the duration of hypotension was significantly greater in group 1 (9.1 minutes) than group 2 (no hypotension). Peak changes in heart rate/systolic blood pressure product (RPP) increased significantly from control in both groups (group 1, 34% and group 2, 71%). Although the percent change in group 2 is twice that in group 1 at peak hypertension, the RPP values were not significantly different. The incidence and degree of hypertension in both groups were unrelated to preoperative ventricular function. We conclude that the morphine anesthetic technic was superior to the ketamine technic in this study, but that neither anesthetic regimen adequately controls the autonomic nervous system in patients with ischemic heart disease.
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