Journal of Anesthesia

, Volume 9, Issue 3, pp 224–228 | Cite as

Endocrine responses to total intravenous anesthesia with droperidol, fentanyl, and ketamine in cardiac patients

  • Kazuyoshi Hirota
  • Shigeharu Wakayama
  • Kazuho Sugihara
  • Tsuyoshi Kudo
  • Tetsuhiro Sakai
  • Naoki Kotani
  • Hironori Ishihara
  • Akitomo Matsuki
Original Articles

Abstract

Ketamine-induced sympathetic stimulation can be inhibited by administration of sedatives such as benzodiazepines, droperidol, or opioids. We have developed total intravenous anesthesia with ketamine in combination with droperidol and fentanyl (DFK) and have used this anesthetic method in more than 4000 surgical cases. In this study, we compared DFK in cardiac surgery with isoflurane-fentanyl anesthesia (AOI-F). Fourteen patients undergoing aortocoronary artery bypass graft surgery were randomly assigned to the DFK or AOI-F groups. The endocrine responses of the patients were evaluated from the plasma, levels of cortisol, antidiuretic hormone (ADH), atrial natriuretic peptide (ANP), and aldosterone. In both groups, anesthesia per se did not induced any significant changes in the hormones. Although cortisol and ADH increased during surgery, ANP and aldosterone did not change appreciably. All hormones were significantly elevated after the end of cardiopulmonary bypass. There were no significant differences in any of the hormones, blood pressure, and heart rate measured at different points in both groups. These results showed that DFK anesthesia as a total intravenous anesthesia deserves to be studied in more depth.

Key words

Endocrine responses Cardiopulmonary bypass Total intravenous anesthesia Ketamine 

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References

  1. 1.
    Tuman KJ, Ivankovich AD (1990) The role of ketamine in cardiac anesthesia. In: Domino EF (ed) Status of ketamine in anesthesiology. NPP Books, Ann Arbor pp 441–451Google Scholar
  2. 2.
    Idvall J, Ahlgrén I, Aronsen KF, Stenberg P (1979) Ketamine infusions: Pharmacokinetics and clinical effects. Br J Anaesth 51:1167–1172PubMedGoogle Scholar
  3. 3.
    Hashimoto H, Araki I, Sato T, Matsuki A (1991) Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine.—7. Effects on natural killer cell activity (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 40:912–917Google Scholar
  4. 4.
    Kimura F, Hashimoto Y, Shimodate Y (1991) Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine.—8. Hepatic and renal functions following prolonged surgical operation of over 10 hours (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 40:1371–1374Google Scholar
  5. 5.
    Ishihara H, Matsuki A, Hashimoto H, Koh H, Kudo T, Ishikawa T (1992) Clinical study of total intravenous anesthesia with droperidol, fentanyl and ketamine—15. Application for cardiac anesthesia (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 41:1474–1481Google Scholar
  6. 6.
    Matsuki A, Ishihara H, Sakai T, Kotani N, Hashimoto H, Asai M, Hirota K, Koh H, Wakayama S, Sato Y (1993) Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine.—20. Summary of three thousand cases and the future of this anesthetic method (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 42:1738–1743Google Scholar
  7. 7.
    Hindman BJ, Lillehaug SL, Tinker JH (1993) Cardiopulmonary bypass and the anesthesiologist. In: Kaplan JA (ed) Cardiac anesthesia. Saunders, Philadelphia, pp 919–950Google Scholar
  8. 8.
    Baily DR, Miller ED, Kaplan JA, Rogers PW (1975) The renin-angiotensin-aldosterone system during cardiac surgery with morphine-nitrous oxide anesthesia. Anesthesiology 42: 538–544CrossRefGoogle Scholar
  9. 9.
    Oyama T, Kudo T, Kudo M, Matsuki A, Miyata T, Kangawa K, Matsuo H (1986) Plasma concentration of α-human atrial natriuretic polypeptide (α-hANP) during cardiopulmonary bypass under fentanyl anesthesia. Agressologie 27:687–689PubMedGoogle Scholar
  10. 10.
    Takino Y, Sumida Y, Hayashi H, Miyakawa T (1990) α-Atrial natriuretic peptide, antidiuretic hormone and aldosterone levels in patients undergoing aortocoronary grafting under high dose fentanyl anesthesia (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 39:1514–1518Google Scholar
  11. 11.
    Tuman KJ, Kean DM, Spiess BD, McCarthy RJ, Silins A, Ivankovich AD (1988) Effects of high-dose fentanyl on fluid and vasopressors requirements after cardiac surgery. J Cardiothorac Anesth 2:419–429CrossRefPubMedGoogle Scholar
  12. 12.
    Oyama T, Matsumoto F, Kudo T (1970) Effect of ketamine on adreno-cortical function in man. Anesthe Analg 49:697–700Google Scholar
  13. 13.
    Zsigmond EK, Kelsch RC, Kothary SP (1970) Plasma free norepinephrine concentration during induction with ketamine. Rev Braz Anest 22:443–451Google Scholar
  14. 14.
    Hirota K, Kudo A, Dobashi N (1992) Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine.—14. Effect on epidural pressure (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 41:964–967Google Scholar
  15. 15.
    Asano M, Kosaka Y (1986) Changes of epidural pressure and cerebrospinal fluid pressure during abdominal surgery (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 35:1694–1700Google Scholar
  16. 16.
    Asano M, Ohoka T, Kosaka Y (1987) Relation between epidural pressure and cerebrospinal fluid pressure in dogs (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 36:89–93Google Scholar
  17. 17.
    Lehtinen AM, Fyhrquist F, Kivalo I (1984) The effect of fentanyl on arginine vasopressin and cortisol secretion during anesthesia. Anesth Analg 63:25–30PubMedCrossRefGoogle Scholar
  18. 18.
    Iida T, Tsubo T, Matsuki A, Kudo T, Kudo M, Oyama T (1988) Effects of isoflurane anesthesia and surgery on plasma concentrations of α-hANP and other stress hormones in man (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 37:147–151Google Scholar
  19. 19.
    Murakawa T, Kudo T, Kudo M, Matsuki A, Oyama T (1989) Effects of intervention on plasma levels of antidiuretic hormone and α-human atrial natriuretic polypeptide under sevoflurane anesthesia (in Japanese with English abstract). Masui (Jpn J Anesthesiol) 38:1195–1200Google Scholar
  20. 20.
    Vollmar AM, Arendt RM, Schultz R (1987) The effect of opioids on rat plasma atrial natriuretic peptide. Eur J Pharmacol 143:314–321CrossRefGoogle Scholar
  21. 21.
    Hoffman WE, Phillips MI, Kimura B (1989) Plasma atrial natriuretic polypeptide and angiotensin II in rats during anesthesia and volume loading. Anesth Analg 68:40–45PubMedCrossRefGoogle Scholar

Copyright information

© JSA 1995

Authors and Affiliations

  • Kazuyoshi Hirota
    • 1
  • Shigeharu Wakayama
    • 2
  • Kazuho Sugihara
    • 2
  • Tsuyoshi Kudo
    • 1
  • Tetsuhiro Sakai
    • 1
  • Naoki Kotani
    • 1
  • Hironori Ishihara
    • 1
  • Akitomo Matsuki
    • 1
  1. 1.Department of AnesthesiologyUniversity of Hirosaki School of MedicineHirosakiJapan
  2. 2.Department of AnesthesiologyAomori-Rosai HospitalHachinoheJapan

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