A Comparison of the Acute Effects of Intravenous Induction Agents (Thiopentone, Methohexitone, Propanidid, Althesin, Ketamine, Piritramide and Etomidate) on Haemodynamics and Myocardial Oxygen Consumption in Dogs

Patschke, D.; Brückner, J. B.; Gethmann, J. W.; Tarnow, J.; Weymar, A.

doi:10.1007/978-3-642-66787-9_8

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…A 1.5 mg.kg − 1 intravenous bolus of lidocaine effectively limits increase in arterial pressure during aortic canulation [26]. Concerning the use of ketamine, its sympathomimetic effect could potentially lead to an increase in [27]. Even if our OFA patients received a larger intraoperative amount of ketamine, no significant difference in postoperative hs-cTnI level was observed.…”

Section: Feasibilitymentioning

confidence: 80%

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Aguerreche¹,

Cadier²,

Beurton

et al. 2021

BMC Anesthesiol

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Background No previous study investigated the dexmedetomidine-based opioid-free anesthesia (OFA) protocol in cardiac surgery. The main objective of this study was to evaluate the feasibility and the postoperative opioid-sparing effect of dexmedetomidine-based OFA in adult cardiac surgery patients. Methods We conducted a single-centre and retrospective study including 80 patients above 18 years old who underwent on-pump cardiac surgery between November 2018 and February 2020. Patients were divided into two groups: OFA (lidocaine, ketamine, dexmedetomidine, MgSO4) or opioid-based anaesthesia (remifentanil and anti-hyperalgesic medications such as ketamine and/or MgSO4 and/or lidocaine at the discretion of the anesthesiologist). The primary endpoint was the total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours. Secondary outcomes included perioperative hemodynamics, post-operative maximal pain at rest and during coughing and adverse outcomes. Data are expressed as median [interquartile range]. Results Patients in the OFA-group had a higher EuroSCORE II, with more diabetes, more dyslipidemia and more non-elective surgery but fewer smoking history. In the OFA group, the median loading dose of dexmedetomidine was 0.6 [0.4–0.6] μg.kg− 1 while the median maintenance dose was 0.11 μg.kg− 1.h− 1 [0.05–0.20]. In 10 (25%) patients, dexmedetomidine was discontinued for a drop of mean arterial pressure below 55 mmHg. The median total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours was lower in the OFA group (15.0 mg [8.5–23.5] versus 30.0 mg [17.3–44.3], p < 0.001). While no differences were seen with rest pain (2.0 [0.0–3.0] versus 0.5 [0.0–5.0], p = 0.60), the maximal pain score during coughing was lower in OFA group (3.5 [2.0–5.0] versus 5.5 [3.0–7.0], p = 0.04). In OFA group the incidence of atrial fibrillation (18% versus 40%, p = 0.03) and non-invasive ventilation use (25% versus 48%, p = 0.04) were lower. The incidence of bradycardia and the intraoperative use of norepinephrine were similar between both groups. Conclusion Dexmedetomidine-based OFA in cardiac surgery patients is feasible and could be associated with a lower postoperative morphine consumption and better postoperative outcomes. Further randomized studies are required to confirm these promising results and determine the optimal associations, dosages, and infusion protocols during cardiac surgery. Graphical abstract

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Section: Feasibilitymentioning

confidence: 80%

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Aguerreche¹,

Cadier²,

Beurton

et al. 2021

BMC Anesthesiol

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“…Third, the heart rate responses to the agents studied correspond roughly with those found in other species. Whereas etomidate affects heart rate little in dogs as well as in man, the others elicit pronounced tachycardia in both species (Patschke et al, 1977;Arndt and Zindler, 1978). In nonpremedicated man, for example, heart rate increases by 20 beatmin" 1 or 30% on average for recommended clinical doses of barbiturates, Althesin and ketamine, and by 45 beat min~' after complete by guest on November 4, 2016 http://bja.oxfordjournals.org/ Downloaded from vagolysis with atropine 0.04mg kg" 1 (Robinson et al, 1966).…”

Section: Table I Effects Of the Four Anaesthetics On Acttmties Of Vamentioning

confidence: 99%

“…The estimate based on this comparison agrees fully with the neurophysiologically documented vagal inhibition in case of ketamine, but is smaller for Althesin and methohexitone. Yet, considering the dose-dependency of the heart rate effects (Patschke et al, 1977) and the problem of comparing equipotency of doses between species, not much emphasis can be put on these differences. It is presumably, therefore, the central vagolytic action which determines the heart rate response to these agents in man also.…”

Section: Table I Effects Of the Four Anaesthetics On Acttmties Of Vamentioning

confidence: 99%

Efferent Vagal Discharge and Heart Rate in Response to Methohexitone, Althesin, Ketamine and Etomidate in Cats

Inoue

Arndt

1982

British Journal of Anaesthesia

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The effects of methohexitone, Althesin, ketamine and etomidate on single fibre discharge of cardiac vagal efferents and on heart rate were studied in cats. Cardiac vagal efferents were inhibited markedly and regularly for equihypnotic doses of methohexitone (2.0 mg kg-1), Althesin (0.1 ml kg-1) and ketamine (5.0 mg kg-1), but not of etomidate (0.8 mg kg-1). These inhibitory effects were independent of arterial pressure and mirrored the increases of heart rate elicited by the first three agents. Etomidate did not consistently affect cardiac vagal discharge or heart rate. Thus methohexitone. Althesin and ketamine inhibit efferent cardiac vagal drive by their central action independently of baroreflex function. This central vagolysis is probably the cause of their positive chronotropic effects.

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“…Earlier investigations revealed that etomidate, in comparison to other i.v. anaesthetic agents, produced less cardiovascular depression (Doenicke et al, 1973;Doenicke et al, 1974;Holdcroft et al, 1976;Patschke et al, 1977b;Colvin et al, 1979). We observed that etomidate decreased the systemic arterial pressure, stroke volume, cardiac output, LV dP/dr max and myocardial wall thickness in a dose-dependent manner; changes which were relatively minor following the lowest dose,-a dose approximately equivalent to that required for surgical anaesthesia.…”

Section: Systemic and Regional Haemodynamicsmentioning

confidence: 51%

“…Although there was a tendency for myocardial oxygen demand, oxygen uptake and blood flow to decrease, the changes were not significant with any of the doses studied. Clinical investigations have also shown that etomidate has only a slight effect on myocardial oxygen balance (Kettler et al, 1974;Patschke et al, 1977a). Furthermore, there was no transmural redistribution of myocardial blood flow.…”

Section: Systemic and Regional Haemodynamicsmentioning

confidence: 98%

Cardiovascular Effects of Etomidate With Emphasis on Regional Myocardial Blood Flow and Performance

Prakash

Dhasmana

Verdouw

et al. 1981

British Journal of Anaesthesia

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The effects of 30-min infusions of etomidate 0.03, 0.12 and 0.24 mg kg-1 min-1 on systemic and regional haemodynamic variables and cardiac performance and metabolism were studied in pigs. The drug caused moderate, but dose-dependent, decreases in the cardiac output, arterial pressure and LVdP/dt max. Myocardial wall thickening, measured by echographic analysis, was decreased by the drug. However, heart rate, myocardial blood flow distribution and myocardial metabolism of lactate, glucose and free fatty acids remained unchanged. Cerebral blood flow was decreased substantially. However, renal blood flow changed only slightly.

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A Comparison of the Acute Effects of Intravenous Induction Agents (Thiopentone, Methohexitone, Propanidid, Althesin, Ketamine, Piritramide and Etomidate) on Haemodynamics and Myocardial Oxygen Consumption in Dogs

Cited by 6 publications

References 15 publications

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Efferent Vagal Discharge and Heart Rate in Response to Methohexitone, Althesin, Ketamine and Etomidate in Cats

Cardiovascular Effects of Etomidate With Emphasis on Regional Myocardial Blood Flow and Performance

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