Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states.
OBJECTIVE
This study compared the hemodynamic effects of a propofol infusion with fentanyl analgesia in patients undergoing cardiac surgery with normal and low cardiac output states. Low cardiac output was defined as a cardiac index less than 2.5 L/min/m2 with a minimum pulmonary capillary wedge pressure of 7 mmHg.


METHODS
A prospective and open study.


METHODS
A single center cardiothoracic unit within a teaching hospital.


METHODS
Patients were assigned to group P, poor cardiac output or group N, normal cardiac output, after thermodilution pulmonary artery catheter assessments.


METHODS
Both groups received a propofol infusion, 8 mg/kg/hr, until induction of anesthesia, followed by 4 mg/kg/hr until the intensive care unit. Fentanyl, 15 micrograms/kg, and pancuronium, 0.15 mg/kg, were administered after induction. The lungs were ventilated with oxygen.


RESULTS
Hemodynamic assessments were repeated at intervals until cardiopulmonary bypass. Changes within and between groups were compared using t tests on percentage change from baseline. Group N had significantly greater decreases in cardiac index, stroke volume, and left ventricular stroke work index than group P. There were comparable decreases in mean arterial pressure on induction of anesthesia, 14% and 8% in group N and group P, respectively. In both groups, right ventricular ejection fraction was unchanged.


CONCLUSIONS
The use of a propofol infusion for induction and maintenance of anesthesia in patients with low cardiac output states undergoing cardiac surgery is not contraindicated.
Sherry
K M
KM
Department of Anesthesia, Northern General Hospital, Sheffield, England.
Sartain
J
J
Bell
J H
JH
Wilkinson
G A
GA
D000701:Analgesics, Opioid / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects*; D002303:Cardiac Output, Low / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010197:Pancuronium / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010197:Pancuronium; D005283:Fentanyl; D015742:Propofol