Changes in left ventricular end-diastolic area, end-systolic wall stress, and fractional area change during anesthetic induction with propofol or thiamylal

Yamaura, Ken; Hoka, Sumio; Okamoto, Hirotsugu; Kimura, Tadashi; Akiyoshi, Kozaburo; Takahashi, Shosuke

doi:10.1007/s005400070021

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…We primarily adopted LA and sedation with the hypothesis that this would lead to a reduced incidence of SCI, given the more stable hemodynamic profile without general anesthetic agents 5,6,25 and the ability to immediately detect neurologic symptoms. Our neuroprotective strategy is to increase the target MAP (>90 mm Hg), optimization of the levels of hemoglobin (>100 g/L), and immediate insertion of a spinal drain while ensuring appropriate reversal of anticoagulation and satisfactory platelets levels.…”

Section: Discussionmentioning

confidence: 99%

“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair

et al. 2021

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Introduction Endovascular repair of thoracoabdominal aortic aneurysms carries a risk of spinal cord ischemia, the causes of which remain uncertain. We hypothesized that local anesthesia (LA) with conscious sedation could abrogate the potential suppressive cardiovascular effects of general anesthesia (GA) and facilitate intraoperative monitoring of neurological function. Here, we examine the feasibility of this technique during fenestrated (FEVAR) or branched endovascular aortic repair (BEVAR). Materials and Methods Consecutive patients undergoing FEVAR or BEVAR under LA and conscious sedation by a team at a single center were analyzed. Patients received conscious sedation using intravenous remifentanil and propofol infusions in conjunction with a local anesthetic agent. No patient had a prophylactic spinal drain inserted. Outcome measures included conversion to GA, need for vasopressors and/or spinal drainage, length of stay, complications, and patient survival. Results A total of 44 patients underwent FEVAR or BEVAR under LA and conscious sedation. The cohort included thoracoabdominal aortic aneurysms (n=41) and pararenal aneurysms treated with endografts covering the supraceliac segment (n=3). Four patients (9%) required conversion to GA at a median operative duration of 198 minutes (range 97–495 minutes). Vasopressors were required intraoperatively in 3 of the cases that were converted to GA. No patient developed spinal cord ischemia and none had insertion of a spinal drain. The median hospital length of stay was 4 days (range 2–41 days). Postoperative delirium and hospital-acquired pneumonia was seen in 7% of patients. All patients survived to 30 days, with 95% alive at a median follow-up of 15 months (range 3–26 months). Conclusion LA and conscious sedation is a feasible anesthetic technique for the endovascular repair of thoracoabdominal aortic aneurysms.

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Section: Discussionmentioning

confidence: 99%

“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair

et al. 2021

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“…Severe hypotension frequently occurs within 10 min after induction of general anesthesia and is associated with increase mortality, especially when propofol is used for induction of anesthesia . The cardio‐depressant effects of intravenous anesthetic agents relate rather to reduction of the preload and afterload, than to a reduction of left ventricular contractility . Different treatment attempts have been described to address acute left ventricular impairment during MitraClip .…”

Section: Discussionmentioning

confidence: 99%

Intra‐aortic balloon counterpulsation pump in heart failure patients during MitraClip implantation—A propensity‐score matched analysis

Keßler

Seeger

Wöhrle

et al. 2018

Cathet Cardio Intervent

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Objectives: To analyze 30-day and 6-month results after percutaneous mitral valve repair using an IABP as circulatory support.Background: The use of intra-aortic balloon counterpulsation pump extended the spectrum of cardiovascular interventions.Methods: Since 2014, 17 patients of 365 patients (4.7%) at our center received an IABP during MitraClip implantation procedure. We compare the periprocedural results to a control group of 17 patients treated with MitraClip without an IABP support. To adjust for differences of baseline characteristics a propensity-score matching for age, baseline blood pressure, preoperative EuroSCORE II and left ventricular ejection fraction was performed. The decision for prophylactic implantation of an IABP was at the discretion of the interventionalist. For both groups, clinical results up to 6 months were evaluated.Results: The IABP group had higher NT-pro BNP levels at baseline and increased left ventricular diameters. The procedure was more often categorized as "urgent" due to refractory heart failure in the IABP group. All procedures were carried out successfully, thereby achieving a sufficient MR reduction in both groups. Length of hospital stay was significantly longer in the IABP group 11.7 AE 14 days (compared to 6.5 AE 2.9 days in the No IABP group, P < 0.01). All patients in both groups had an event-free 30-day follow-up. MACCE rate was higher in the IABP group compared to the No IABP group (47.1% vs. 23.5%, P = 0.14).Conclusion: Insertion of an IABP during MitraClip procedure might be a feasible option to achieve comparable results and may provide additional safety and procedural hemodynamic stability in the setting of high-risk percutaneous mitral valve repair. K E Y W O R D SHeart failure, IABP, MitraClip

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“…Previous studies suggest that intraoperative hypotension is associated with cardiovascular events and acute kidney injury in patients undergoing non-cardiac surgery [3][4][5]. Propofol often leads to hypotension during induction of anesthesia, and the risk increases with age [6][7][8][9]. Given the risk of perioperative complications in elderly patients [10][11][12], preventive measures are required against hypotension during general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: A single-center, randomized, controlled trial

Sekiguchi

Kinoshita

Kawanishi

et al. 2022

Preprint

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Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 µg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP tended to decrease after induction of anesthesia in both the groups, without significant differences between the groups (-41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: -8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Remimazolam group tended to have a lower frequency of hypotension (MAP < 65 mmHg) than propofol group (7 [35%] and 11 [55%] cases, respectively; p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, the choice, dose, and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol. Trial registration: UMIN-CTR (UMIN000045612).

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Changes in left ventricular end-diastolic area, end-systolic wall stress, and fractional area change during anesthetic induction with propofol or thiamylal

Abstract: The more profound hypotension observed during induction of anesthesia with propofol is due to the greater decrease in preload and afterload than with thiamylal, but not to a decrease in LV contractility.

Cited by 7 publications

References 30 publications

“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair

“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair

Intra‐aortic balloon counterpulsation pump in heart failure patients during MitraClip implantation—A propensity‐score matched analysis

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: A single-center, randomized, controlled trial

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