Abstract
In 24 premedicated patients about to undergo coronary artery bypass surgery, anaesthesia was induced with either etomidate 0.3 mg kg-1, alfathesin 0.07 ml kg-1 or thiopentone 3.0 mg · kg-1, in combination with fentanyl. Detailed haemodynamic studies were made including measurements of arterial pressure, right atrial pressure, pulmonary artery and pulmonary capillary wedge pressure, heart rate, cardiac output and monitoring of the lead V5 electrocardiogram. Cardiovascular data were recorded in the awake patient and one, three and five minutes after induction of anaesthesia. Following fentanyl 0.01 mg · kg-1 and suxamethonium 1.0 mg · kg-1 the trachea was intubated and further measurements were made immediately and five minutes after intubation. Induction of anaesthesia using the new non-barbiturate agent etomidate was associated with a remarkable cardiovascular stability. No major changes in heart rate, arterial blood pressure, cardiac index, pulmonary artery pressure, right and left ventricular filling pressure or total peripheral resistance occurred. The addition of fentanyl decreased heart rate and cardiac index slightly and was associated with a significant reduction of the rate-pressure product. The cardiovascular effects of thiopentone were very similar to those of etomidate, except for a small increase in heart rate with thiopentone. Alfathesin produced a significant fall in arterial pressure, cardiac index and stroke index, while heart rate increased. The rate-pressure product remained unchanged. The combination of alfathesin with fentanyl produced an additional decrease in blood pressure and cardiac index.
None of the three induction procedures was associated with cardio-vascular stimulation during laryngoscopy and tracheal intubation. Our findings suggest that either thiopentone or etomidate combined with fentanyl are acceptably safe in cardiac patients while alfathesin with fentanyl appears to be more detrimental to the circulation.
Résumé
Chez 24 patients devant subir un pontage aorto-coronarien, on a utilisé après prémédication (mépéridine 1 mg kg-1, prométhazine 0.5-1 mg·kg-1 et atropine 5-10 μg· kg-1 90 minutes auparavant), comme agent ďinduction ľéthomidate (0.3 mg-kg-1) ľalfathésin (0.07 ml kg-1) ou le thiopental (3 mg·kg-1), en association avec le fentanyl. Une étude hémodynamique détaillée a été effectuée. Elle incluait les mesures des pressions artérielle systolique, auriculaire droite, pulmonaire et pulmonaire bloquée, de la fréquence et du débit cardiaque, ainsi que du monitoring de la dérivation V5 de ľECG. On a effectué ces mesures chez le patient éveillé, puis une, trois et cinq minutes après ľinduction de ľanesthésie. Après une dose de fentanyl (0.01 mg·kg-1) et de succinylcholine (1 mg·kg-1), on a procédà è ľintubation et une nouvelle série de mesures a été effectuée cinq minutes plus tard.
Une stabilité cardiovasculaire remarquable a été observée dans les inductions avec le nouvel agent non barbiturique étomidate. On n’a observé aucun changement majeur de la fréquence cardiaque, des pressions de remplissage droite et gauche, ainsi que de la résistance périphérique. Après addition de fentanyl, on a constaté un ralentissment léger de la fréquence et du débit cardiaque, ainsi qu’une diminution significative du produit fréquence pression.
Les effets cardiovasculares du thiopental étaient très similaires à ceux de ľétomidate si ce n’est ďune légère augmentation de la fréquence cardiaque après ľinjection de ce barbiturique. Quant à ľalfathésin, il a causé une chute significative de la pression artérielle, de ľindex cardiaque et de ľindex ďéjection, avec une augmentation de la fréquence cardiaque. Le produit fréquence-pression demeurait inchangé. Ľaddition de fentanyl contribuait à diminuer davantage la pression artérielle et ľindex cardiaque.
Aucune des trois méthodes étudiées n’a été associée avec une stimulation cardiovasculaire durant la laryngoscopie et ľintubation. Nos travaux suggèrent que ľéthomidate ou le thiopental associés au fentanyl sont acceptables au point de vue sécurité des cardiaques, alors que ľalfathésin avec le fentanyl semble affecter davantage la circulation.
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Tarnow, J., Hess, W. & Klein, W. Etomidate, alfathesin and thiopentone as induction agents for coronary artery surgery. Canad. Anaesth. Soc. J. 27, 338–344 (1980). https://doi.org/10.1007/BF03007454
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DOI: https://doi.org/10.1007/BF03007454