Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 1995
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-fentanyl versus isoflurane-fentanyl anesthesia for coronary artery bypass grafting: effect on myocardial contractility and peripheral hemodynamics.
To avoid intraoperative awareness and postoperative respiratory depression from high-dose opioid anesthesia, propofol (P), or isoflurane (I) has been combined with moderate-dose opioid with varying results. However, the effects of both P and I on myocardial contractility and left ventricular afterload have not been completely quantified. The end-systolic pressure-diameter relationship (ESPDR) of the left ventricle (LV) is a reliable method to quantitatively assess LV contractility because it is relatively independent of changes in preload and incorporates afterload changes. ⋯ Anesthesia was maintained throughout the procedure with a zero-order intravenous (IV) continuous infusion of P, 3 mg/kg/h (PF group), or with isoflurane inhalation of 0.6% (IF group), supplemented by intermittent boluses (5 micrograms/kg) of fentanyl (up to a total maintenance dose of 30 micrograms/kg). After intubation, a cross-section of the LV was visualized by two-dimensional transesophageal echocardiography and an m-mode echocardiogram was obtained at the maximum anterior-posterior diameter. The radial artery pressure tracing and the ECG were simultaneously recorded with the M mode.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Feb 1995
Randomized Controlled Trial Clinical TrialCardiorespiratory response of intravenous angiotensin-converting enzyme inhibitor enalaprilat in hypertensive cardiac surgery patients.
Twenty-four patients undergoing elective coronary artery bypass surgery were studied. Either the angiotensin-converting enzyme (ACE) inhibitor enalaprilat, 0.06 mg/kg, (n = 12), or saline solution (= control group; n = 12), was randomly and blindly administered intravenously when the mean arterial blood pressure (MAP) increased to 90 mmHg after induction of anesthesia. Cardiorespiratory parameters were studied before injection, during the subsequent 30 minutes, precardiopulmonary bypass (CPB), post-CPB, and at the end of surgery. ⋯ There were no differences from the control patients with regard to changes in right ventricular hemodynamics (right ventricular ejection fraction, right ventricular end-diastolic volume, right ventricular end-systolic volume), pulmonary gas exchange (PaO2), or intrapulmonary right-to-left shunting (Qs/Qt). VO2 increased only in the enalaprilat patients (from 179 +/- 28 to 230 +/- 30 mL/min) (p < 0.05). Cardiorespiratory parameters did not differ between the two groups post-CPB.(ABSTRACT TRUNCATED AT 250 WORDS)