title: Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function.
abstract: OBJECTIVE
  To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients.
  
  
  METHODS
  Prospective, randomized.
  
  
  METHODS
  Major community university-affiliated hospital.
  
  
  METHODS
  Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%).
  
  
  METHODS
  Anesthesia was performed using remifentanil, 0.2 to 0.3 microg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 microg x mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10).
  
  
  RESULTS
  Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m(2) in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 +/- 1.0 mg/kg/hr) than in the MCI patients (3.0 +/- 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 +/- 2.4 min) versus the TCI group (15.6 +/- 6.8 min). Costs were significantly lower in MCI patients (34.73 dollars) than in TCI patients (44.76 dollars).
  
  
  CONCLUSIONS
  In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator.
authors.affiliation: Department of Anesthesiology, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lehmann
authors.forename: J
authors.initials: J
authors.lastname: Boldt
authors.forename: R
authors.initials: R
authors.lastname: Römpert
authors.forename: E
authors.initials: E
authors.lastname: Thaler
authors.forename: B
authors.initials: B
authors.lastname: Kumle
authors.forename: U
authors.initials: U
authors.lastname: Weisse
mesh_terms: D000771:Anesthesia, Intravenous / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000191:economics; D017147:Defibrillators, Implantable; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000191:economics; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics; D011446:Prospective Studies; D000077208:Remifentanil; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol