Summary
The acute effects of althesin, etomidate and fentanyl upon haemodynamics, myocardial contractility and oxygen consumption of the heart were studied in healthy premedicated patients (n = 15) lightly anaesthetized with N2O-O2 (ratio 2:1), 0.3 volumes per cent of halothane and isoflurane respectively. All individuals were ventilated at a normal level. The patients (n = 9) in the halothane group received etomidate 0.3 mg/kg and 20 minutes later althesin 0.075 ml/kg intravenously. In a second group of 6 patients on isoflurane fentanyl 0.01 mg/kg was given. Etomidate did not affect the cardiovascular system significantly. While the decrease in blood pressure after althesin (24 per cent) was the result of a reduction in total peripheral resistance (32 per cent), hypotension associated with fentanyl (23 per cent) was caused by diminished cardiac output due to bradycardia (18 per cent). Load data, heart rate, and maximum dp/dt indicated moderate negative inotropic properties only of althesin. Using the complex haemodynamic parameter developed by Bretschneider the myocardial oxygen consumption was calculated. The energy demand of the heart decreased with etomidate, althesin and fentanyl by 14 per cent, 16 per cent and 32 per cent respectively.
It is concluded that the risk of cardiovascular depression at induction in patients with impaired myocardial performance and coronary insufficiency can be minimized with etomidate and/or fentanyl.
Résumé
Les effets aigus de ľalthésine, de ľétomidate et du fentanyl sur ľhémodynamique, la contractilité myocardique et la consommation ďoxygène du cœur ont été étudiés chez 15 patients en bon état général, anesthésiés légèrement avec N2O-O2 (2:1) et 0.3 pour cent ďhalothane, ou N2O-O2 (2:1) et 0.3 pour cent ďisoflurane. Tous ont été normoventilés. Les neuf patients anesthésiés à ľhalothane ont reçu 0.3 mg/kg ďétomidate et 20 minutes plus tard 0.075 mg/kg ďalthésine par voie intra-veineuse, tandis que ľautre groupe de six patients anesthésiés à ľisoflurane a reçu 0.01 mg/kg de fentanyl.
Ľétomidate n’a pas semblé affecter le système cardio-vasculaire de façon significative.
La diminution (24 pour cent) de la pression artérielle après ľathésine résultait ďune diminution (32 pour cent dans la résistance totale périphérique; ľhypotension observée après le fentanyl (23 pour cent) était attribuable à une diminution du débit cardiaque (technique de thermodilution) par bradycardie (18 pour cent). Les données de pré et post-charge, la fréquence cardiaque, le rapport dp/dt max, ont montré des propriétés inotropiques négatives modérées avec ľalthésine seulement. Grâce au paramètre hémodynamique complexe développé par Bretschneider, on a pu quantifier la consommation du myocarde en O2: la demande énergétique du cœur a diminué avec ľétomidate, ľalthésine et le fentanyl, soit dans ľordre de 14 pour cent, de 16 pour cent et de 32 pour cent.
Nous concluons que le risque de dépression cardio-vasculaire à ľinduction chez des patients à fonction myocardique comprise et porteurs ďinsuffisance coronarienne peut être diminué avec ľemploi de ľétomidate et/ou du fentanyl.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Braunwald, E. Control of myocardial oxygen consumption. Amer. J. Cardiol.27, 416 (1971).
Bretschneider, H.J. Aktuelle Probleme der Koronardurchblutung und des Myokardstoffwechsels. Regensb. ärztl. Fortbildg.15, 1 (1967).
Bretschneider, H.J., Cott, L.A., Hensel, I., Kettler, D., &Martell, J. Ein neuer komplexer hämodynamischer Parameter aus 5 additiven Gliedern zur Bestimmung des O2-Bedarfs des linken Ventrikels. Pfluegers Arch. Eur. J. Physiol.319, 14 (1970).
Bretschneider, H.J. Die hämodynamischen Determinanten des O2 — Bedarfs des Herzmuskels. Arzneimittelforschung (Drug Res.)21, 1515 (1971).
Bretschneider, H.J., Martel, J., Hellige, G., Hensel, I., &Kettler, D. Korrelation des endsystolischen Ventrikelvolumens pro Gewichtseinheit (ESV/100 g) zu Potenzfunktionen des arteriellen Druckes (P) und der ventrikulären Druckanstiegsgeschwindigkeit (dp/dt max). Verh. Dtsch. Ges. Kreislaufforsch.38, 233 (1972).
Campbell, D., Forrester, A.C., Miller, D.C., Hutton, I., Kennedy, J.A., Lawrie, I.D.V., &Lorimer A.R. A preliminary clinical study of CT 1431 — a steroid anaesthetic agent. Brit. J. Anaesth.43, 14 (1971).
Clark, R.S.J., Carson, I.W., &Dundee, J.W. Some aspects of the clinical pharmacology of Althesin. Postgrad. Med. J., Supplem. 2,48, 62 (1972).
Clark, R.S.J., Montgomery, S.J., Dundee, J.W., &Bovill, J.G. Clinical studies of induction agents XXXIX: CT 1341, a new steroid anaesthetic. Brit J. Anaesth.43, 947 (1971).
Doenicke, A., Gabanyi, D., Lemcke, H., &Schurk-Bulich, M. Kreislaufverhalten und Myokardfunktion nach drei kurzwirkenden i.v. Hypnotika Etomidate, Propanidid, Methohexital. Anaesthesist23, 108 (1974).
Doenicke, A., Lorenz, W., Beigl, R., Bezecny, H., Uhlig, G., Kalmar, L., Praetorius, B., &Mann, G. Histamine release after intravenous application of short-acting hypnotics. Brit. J. Anaesth.45, 1097 (1973).
Egeh, E.I., Saidman, L.J., &Brandstater, B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology26, 756 (1965).
Fennessy, M.R. &Rattray, J.F. Cardiovascular effects of intravenous morphine in the anesthetized rat. Eur. J. Pharmacol.14, 1 (1971).
Foex, P. &Prys-Roberts, C. Pulmonary haemodynamics and myocardial effects of althesin (CT 1341) in the goat. Postgrad. Med. J. Supplem. 2,48: 24 (1972).
Freye, E. Cardiovascular effects of high dosages of fentanyl, meperidine, and naloxone in dogs. Anesth. Analg.53, 40 (1974).
Gordh, T. The effect of althesin on the heartin situ in the cat. Postgrad. Med. J., Supplem. 2,48, 32 (1972).
Gorlin, R. Regulation of coronary blood flow. Brit. HeartJ. 33, Supplement 9.
Hall, L.W. Althesin in the larger animals. Postgrad. Med. J., Supplement 2,48, 55 (1972).
Hempelmann, G., Helms, U., &Waldhausen, E. Hämodynamische Veränderungen durch CT 1341 bei herzchirurgischen Eingriffen. Anaesthesist22, 345 (1973).
Jannssen, P.A.J., Niemegeers, C.J.E., Schellekens, K.H.L., &Lenaerts, F.M. Etomidate, R-(+)-ethyl-1-1-(α-methyl-benzyl)-immidazole-5-carboxylate (R 16 659), a potent, short-acting relatively atoxic intravenous hypnotic agent in rats. Arzneimittelforschung (Drug Res.)21, 1234 (1971).
Kettler, D. Sauerstoffbedarf und Sauerstoffversorgung des Herzens in Narkose. Anaesthesiol. Resuscit.67 (1973).
Kettler, D., Sonntag, H., Donath, K., Regensburger, D., &Schenk, H.D. Hämodynamik, Myokardmechanik, Sauerstoffbedarf und Sauerstoffversorgung des menschlichen Herzens mit Etomidate. Anaesthesist23, 116 (1974).
Kettler, D. &Sonntag, H. Intravenous anaesthetics; coronary blood flow and myocardial oxygen consumption. Acta Anaesth. Belg.3, 384 (1974).
Morgan, M., Lumley, J., &Whitwam, J.G. Etomidate — a new water soluble non-barbiturate intravenous induction agent. Lancet1, 955 (1975).
Nelson, R.R., Gobel, F.L., &Jorgensen, C.R. Hemodynamic predictors of myocardial oxygen consumption during static and dynamic exercise. Circulation50, 1179 (1974).
Ostheimer, G.W., Shanahan, E.A., Guyton, R.A., Daggett, W.M., &Lowenstein, E. Effects of fentanyl nad droperidol on canine left ventricular performance. Anesthesiology42: 288 (1975).
Patschke, D., Brückner, J.B., Gethmann, J.W., Tarnow, J., &Weymar, A. Influence of althesin on coronary blood flow and myocardial oxygen consumption in dogs. Acta Anaesth. Scand.18, 23 (1974).
Patschke, D., Bruckner, J.B., Reinecke, A., Schmicke, P., Tarnow, J., &Eberlein, H.J. Experimentelle Untersuchungen der Kreislaufwirkungen von CT 1341, einem neuen Steroidanaesthetikum. Anaesthesist21, 338 (1972).
Robinson, B.F. Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris. Circulation35, 1073 (1967).
Sapthavichaikul, S., Wisborg, K., &Skovsted, P. The effect of althesin on arterial pressure, pulse rate, preganglionic sympathetic activity and barostatic reflexes in cats. Can. Anaesth. Soc. J.22, 587 (1975).
Savege, T.M., Blogg, C.E., Foley, E.J., Ross, L., Lang, M., &Simpson, B.R. The cardiorespiratory effects of althesin and ketamin. Anaesthesia28, 391 (1973).
Savege, T.M., Foley Eleanor, I., Coultas, R.J., Walton, B., Strunin, L., Simpson, B.R., &Scott, D.F. CT 1341: some effects in man. Anaesthesia26 402 (1971).
Slama, H. &Piiper, J. Direktanzeigendes Rechengerät zur Bestimmung des Herzzeitvolumens mit der Thermoinjektionsmethode. Z. Kreislaufforsch.53, 322 (1964).
Sonnenblick, E.H., Ross, J., Covell, J.W., &Braunwald, E. Velocity of contraction as a determinant of myocardial oxygen consumption. Amer. J. Physiol.209, 919 (1965).
Sonnenblick, H.E., Ross, J., &Braunwald, E. Oxygen consumption of the heart. Amer. J. Cardiol.22, 328 (1968).
Sonntag, H., Schenk, H.D., Regensberger, D., Kettler, D., Hellberg, K., Knoll, D., Donath, U., &Becker, H. Effects of althesin (Glaxo CT 1341) on coronary blood flow and myocardial metabolism in man. Acta Anaesth. Scand.17, 218 (1973).
Sonntag, H. Koronardurchblutung und Energieumsatz des menschlichen Herzens unter verschiedenen Anaesthetika. Anaesthesiol. Resuscit.79 (1974).
Strauer, B.E. Contractile responses to morphine, meperidine, piritramide and fentanyl: a comparative study on the isolated ventricular myocardium. Anesthesiology37, 304 (1972).
Tarnow, J., Brückner, J.B., Eberlein, H.J., Hess, W., &Patschke, D. Haemodynamics and myocardial oxygen consumption during isoflurane (forane) — anaesthesia in geriatric patients. Brit. J. Anaesth.48, 669 (1976).
Wallace, A.G., Skinner, N.S., &Mitchell, J.H. Haemodynamic determinants of the maximal rate of rise of left ventricular pressure. Amer. J. Physiol.205, 30 (1963).
Weymar, A., Eigenheer, F., Gethmann, J.W., Reinecke, A., Patschke, D., Tarnow, J., &Brückner, J.B. Tierexperimentelle Untersuchungen zur Wirkung von Etomidate (R 26 490-Sulfat) auf den Kreislauf und die myokardiale Sauerstoffversorgung. Anaesthesist23, 150 (1974).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Patschke, D., Brückner, J.B., Eberlein, H.J. et al. Effects of althesin, etomidate and fentanyl on haemodynamics and myocardial oxygen consumption in man. Canad. Anaesth. Soc. J. 24, 57–69 (1977). https://doi.org/10.1007/BF03006813
Issue Date:
DOI: https://doi.org/10.1007/BF03006813