title: Inotropic effects of propofol, thiopental, midazolam, etomidate, and ketamine on isolated human atrial muscle.
abstract: BACKGROUND
  Cardiovascular instability after intravenous induction of anesthesia may be explained partly by direct negative inotropic effects. The direct inotropic influence of etomidate, ketamine, midazolam, propofol, and thiopental on the contractility of isolated human atrial tissue was determined. Effective concentrations were compared with those reported clinically.
  
  
  METHODS
  Atrial tissue was obtained from 16 patients undergoing coronary bypass surgery. Each fragment was divided into three strips, and one anesthetic was tested per strip in increasing concentrations (10(-6) to 10(-2) M). Strips were stimulated at 0.5 Hz, and maximum isometric force was measured. Induction agents were studied in two groups, group 1 (n = 7) containing thiopental, midazolam, and propofol, and group 2 (n = 9) consisting of etomidate, ketamine, and propofol.
  
  
  RESULTS
  The tested anesthetics caused a concentration-dependent depression of contractility resulting in complete cessation of contractions at the highest concentrations. The IC50s (mean +/- SEM; microM) for inhibition of the contractility were: thiopental 43 +/- 7.6, propofol 235 +/- 48 (group 1), and 246 +/- 42 (group 2), midazolam 145 +/- 54, etomidate 133 +/- 13, and ketamine 303 +/- 54.
  
  
  CONCLUSIONS
  This is the first study demonstrating a concentration-dependent negative inotropic effect of intravenous anesthetics in isolated human atrial muscle. No inhibition of myocardial contractility was found in the clinical concentration ranges of propofol, midazolam, and etomidate. In contrast, thiopental showed strong and ketamine showed slight negative inotropic properties. Thus, negative inotropic effects may explain in part the cardiovascular depression on induction of anesthesia with thiopental but not with propofol, midazolam, and etomidate. Improvement of hemodynamics after induction of anesthesia with ketamine cannot be explained by intrinsic cardiac stimulation.
authors.affiliation: Department of Anesthesiology, University Hospital Groningen, University of Groningen, The Netherlands.
authors.forename: H P
authors.initials: HP
authors.lastname: Gelissen
authors.forename: A H
authors.initials: AH
authors.lastname: Epema
authors.forename: R H
authors.initials: RH
authors.lastname: Henning
authors.forename: H J
authors.initials: HJ
authors.lastname: Krijnen
authors.forename: P J
authors.initials: PJ
authors.lastname: Hennis
authors.forename: A
authors.initials: A
authors.lastname: den Hertog
mesh_terms: D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D016275:Atrial Function; D003864:Depression, Chemical; D004305:Dose-Response Relationship, Drug; D005045:Etomidate / Q000494:pharmacology; D006325:Heart Atria / Q000187:drug effects; D006801:Humans; D066298:In Vitro Techniques; D007537:Isometric Contraction / Q000187:drug effects; D007649:Ketamine / Q000494:pharmacology; D008874:Midazolam / Q000494:pharmacology; D009200:Myocardial Contraction / Q000187:drug effects*; D015742:Propofol / Q000494:pharmacology; D013268:Stimulation, Chemical; D013874:Thiopental / Q000494:pharmacology
chemical_list: D018686:Anesthetics, Intravenous; D007649:Ketamine; D013874:Thiopental; D008874:Midazolam; D015742:Propofol; D005045:Etomidate