The efficacy, safety, and hemodynamic response to 5 μg/kg, 10 μg/kg, or 20 μg/kg of sufentanil and 0.1 mg/kg pancuronium was evaluated in children between 4 and 12 years of age scheduled for open heart surgery. Systolic time intervals, 2-D echocardiograms, systolic blood pressures (SBP), diastolic blood pressures (DBP), and heart rates (HR) were recorded before and after induction of anesthesia. Significant changes 10 min following induction of anesthesia but before intubation included increases in SBP in the 5 μg/kg group (P< 0.01) and in the ratio of preejection period to left ventricular ejection time in the 20 μg/kg group (P< 0.05). Instances of myoclonic jerking and coughing episodes were observed in all three study groups.Following intubation there were significant (P< 0.05) increases in SBP in all groups, in DBP in the 5 μg/kg group, and in HR in the 5 μg/kg and 10 μg/kg groups. Smaller increases in SBP, DBP, and HR were seen in all groups after skin incision and sternotomy. Mean plasma catecholamine levels showed nonsignificant increases following periods of intraoperative stimulation with wide patient variationsRecovery of responsiveness to command occurred in all groups within one hour from the end of surgery but extubation was impeded by shallow periodic breathing and hypercapnea. The authors conclude that for children undergoing open heart surgery use of sufentanil as a sole anesthetic in bolus form did not provide a reliable depth of anesthesia with any of the induction doses studied.