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Propofol/fentanyl versus etomidate/fentanyl for the induction of anesthesia in patients with aortic insufficiency and coronary artery disease

1992; Elsevier BV; Volume: 6; Issue: 2 Linguagem: Inglês

10.1016/1053-0770(92)90193-b

1532-8422

R. Haessler, C. Madler, S. Klasing, D. Schwender, Klaus Peter,

Anesthesia and Sedative Agents

The purpose of this study was to gain information about the hemodynamic effects following the induction of anesthesia with fentanyl and either 1 mg/kg of propofol (P) or 0.25 mg/kg of etomidate (E) in ASA III–IV patients with aortic insufficiency (AI) or coronary artery disease (CAD). Four patient groups resulted: (1) AI and P, n = 10; (2) AI and E, n = 10; (3) CAD and P, n = 6; and (4) CAD and E, n = 8. Hemodynamics were recorded in the awake state, following induction, intubation, and 10 minutes after intubation. No complications occurred in groups 1, 2, and 4. In 2 patients of group 3, who suffered from three-vessel CAD, induction resulted in severe hypotension associated with an increase in pulmonary capillary wedge pressure. Because of this, the investigation of group 3 was prematurely terminated after the sixth patient. The following changes were observed under general anesthesia: in all four groups, arterial pressure (AP), cardiac index (CI), and left ventricular stroke work index decreased. Significantly different values between group 1 (AI and P) and 2 (AI and E) were observed for heart rate (HR) (P < E), stroke volume (SV) (P > E), arterial elastance (Ea), and systemic vascular resistance (SVR) (P < E); differences between group 3 (CAD and P) and 4 (CAD and E) were seen for AP, Ea, and SVR (P < E each). After tracheal intubation, baseline values of AP and HR were not surpassed in any group. Signs of systolic myocardial dysfunction were present in all groups (P > E). In spite of this, possibly because of the decrease in afterload, a comparable decrease in AP and Cl was observed in groups 1 and 2. In contrast to patients with CAD, patients with AI could be anesthetized as safely with propofol/fentanyl as with etomidate/fentanyl with respect to hemodynamic stability.