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Propofol‐fentanyl anaesthesia in cardiac surgery: a comparison in patients with good and impaired ventricular function
Author(s) -
PHILLIPS A. S.,
McMURRAY T. J.,
MIRAKHUR R. K.,
GIBSON F. M.,
ELLIOTT P.
Publication year - 1993
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1993.tb07173.x
Subject(s) - medicine , propofol , anesthesia , fentanyl , cardiac index , ejection fraction , hemodynamics , heart rate , intubation , mean arterial pressure , vascular resistance , tracheal intubation , blood pressure , stroke volume , cardiac function curve , cardiac output , cardiology , heart failure
Summary The haemodynamic effects of propofol‐fentanyl anaesthesia for elective cardiac surgery were compared in 24 patients with good left ventricular function (ejection fraction > 45%, left ventricular end‐diastolic pressure < 16 mmHg) and nine patients with impaired function. Anaesthesia was induced withfentanyl 25 μg.kg −1 and pancuronium 0.1 mg.kg −1 and was maintained with a variable rate propofol infusion, mean rate 2.61 mg.kg −1 .h −1 in the good ventricular function group and 2.71 mg.kg −1 .h −1 in the impaired function group. Additional fentanyl 7.5 μg.kg −1 was given before sternotomy. Ventilation to normocarbia was with air and oxygen (F io 2 0.6). Haemodynamic measurements were made before induction, after tracheal intubation, before and after sternotomy and before aortic cannulation. There were no significant differences between the groups in any haemodynamic variables during the study. Twenty minutes after intubation both groups showed a decrease from pre‐induction values in mean arterial pressure (p < 0.05) and left ventricular stroke work index (p < 0.05), the reduction in left ventricular stroke work index remaining significant during the prebypass period in both groups. There were no significant changes in right or left sided filling pressures, systemic vascular resistance or heart rate. The technique decreased cardiac work and effectively controlled the autonomic responses to sternotomy in both groups. This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with impaired ventricular function having cardiac surgery.