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This study was designed to assess, in a prospective, randomized, blinded fashion, the hemodynamic effects of different anesthetics used in the prebypass period during coronary artery bypass grafting (CABG) and the effect on incidence of ischemia. Seventy-five patients were randomly assigned to receive sufentanil increments, isoflurane, or enflurane after a standard premedication and anesthetic induction with sufentanil 5 micrograms/kg. Myocardial ischemia was monitored intraoperatively by the anesthesiologist with electrocardiogram (ECG) leads V5(CB5) and II, and by a Holter monitor of the same leads from which recordings were analyzed postoperatively by a cardiologist. A continuous recording of the blood pressure was analyzed to determine the duration of hypertensive responses. Arterial blood pressure control was best in the patients supplemented with anesthetic vapors; patients receiving beta-adrenergic blockers or those receiving isoflurane were less likely to require treatment for tachycardia. All episodes of myocardial ischemia occurred within 5 min of induction-intubation and were diagnosed more frequently by the anesthesiologist than on the Holter monitor (29% vs 9%), with no difference between groups. There were five perioperative myocardial infarctions with no difference between groups. After anesthetic induction with sufentanil 5 micrograms/kg, isoflurane or enflurane given during CABG provides better hemodynamic control than increments of sufentanil and is associated with a similar incidence of prebypass ischemia and perioperative infarction.