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Haemodynamic Response to Nitrous Oxide during High‐Dose Fentanyl Pancuronium Anaesthesia
Author(s) -
MERETOJA O. A.,
TAKKUNEN O.,
HEIKKILÄ H.,
WEGELIUS U.
Publication year - 1985
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1985.tb02174.x
Subject(s) - medicine , anesthesia , fentanyl , cardiac index , cardiac output , ejection fraction , heart rate , hemodynamics , stroke volume , cardiology , blood pressure , heart failure
Ten patients subjected to coronary by‐pass surgery were studied to determine the haemodynamic effects of replacing Fio 2 1.0 normoventilation with nitrous oxide in oxygen (Fio 2 0.3) after induction of anaesthesia with fentanyl (50 μg/kg), flunitrazepam and pancuronium. In all patients the application of N 2 O decreased systemic arterial pressures by an average of 10% ( P <0.001), but left pulmonary arterial pressures and systemic vascular resistance unchanged. The slight bradycardia induced was associated with moderate depression of the cardiac index and the left ventricular stroke work index ( P <0.001) at the time when the rate‐pressure product was decreased by 20% ( P <0.001). The cardiac depression produced by N 2 O was most prominent in patients with left ventricular wall hypokinesia and an ejection fraction below 55%, in whom the cardiac work index was diminished by 29%. The replacement of oxygen with nitrous oxide in oxygen during high‐dose fentanyl‐pancuronium anaesthesia seems not to be associated with sympathetic stimulation, and the myocardial depressant effect of N 2 O should be weighed against the possible reduction in myocardial oxygen consumption with special care in patients with compromised myocardial function.