Hemodynamic Response to Different Anesthetics during Open‐Heart Surgery

Maunuksela, Eeva‐Liisa

doi:10.1111/j.1399-6576.1977.tb01270.x

Cited by 12 publications

(10 citation statements)

References 110 publications

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“…Scopolamine was chosen for its lack of chronotropic effects (GRAVENSTEIN & THORN-BY 1969)) which make it preferable to atropine when tachycardia should be avoided, as in patients with cardiac valvular disease where digitalis is discontinued at least 24 h prior to surgery. The principal haemodynamic action of fentanyl used during perfusion is a minor decrease in systemic vascular resistance (STOELTING et al 1975, MAUNUKSELA 1977. It is therefore not improbable that the action on the systemic vascular resistance of propanidid observed in this study was modified by the simultaneous use of fentanyl.…”

Section: Discussionmentioning

confidence: 66%

The Effect of Propanidid on Systemic Vascular Resistance in Man

Klauber

Christensen

Korshin

et al. 1978

Acta Anaesthesiol Scand

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We have studied the peripheral vascular effect in man of propanidid 6 mg/kg, administered as a bolus injection during cardiopulmonary by‐pass with the aorta cross‐clamped and at constant perfusion flow. Ten measurements in eight patients were performed. A decrease was found in systemic vascular resistance: from 150.7±16.3 to 99.5±10.1 k Pa × s/l. No venous pooling occurred. It is concluded that, in man, propanidid causes a vasodilation which must contribute to the hypotension it causes.

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Section: Discussionmentioning

confidence: 66%

The Effect of Propanidid on Systemic Vascular Resistance in Man

Klauber

Christensen

Korshin

et al. 1978

Acta Anaesthesiol Scand

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“…The cardiovascular effects of fentanyl and halothane have been studied extensively under both experimental and clinical conditions including cardiac surgery ( I , 2, 3 , 4 , $8, I 1, 12). Halothane is generally considered to have a dose-dependent depressant action on the cardiovascular system (1,19,20), concomitant with a reduced oxygen demand and consequently a well-preserved oxygen supply-demand ratio (12, 20). Fentanyl, when used alone, has been shown to be without negative inotropic effects and to have a minimal impact on the circulatory system (3, 5); in fact, recent studies indicate a positive inotropic effect (21).…”

Section: Discussionmentioning

confidence: 99%

“…Systemic vascular resistance (SVR MPa x s x m+) was calculated as SVR = (MAP-CVP mmHg) x CO-' (1 x min-I) x 8 (MAP= mean arterial pressure). Since B-EVF was markedly reduced after bypass (24% as compared with 38%), the SVR value was divided by a viscocity factor derived from the B-EVF value (1 7) in order to obtain information of changes in vascular tone.…”

Section: Calculated Parametersmentioning

confidence: 99%

“…The good results of coronary artery bypass grafting have led to a great increase in the number of patients subjected to this type of surgery. The myocardial oxygen supply-demand ratio is easily disturbed in patients with coronary artery stenosis and consequently much interest has been focused on the effect of various anaesthetic agents in this type of patient (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Inhalational as well as intravenous techniques have been recommended, but there have been only a limited number of randomized comparative studies (1,4,8,11,14).…”

mentioning

confidence: 99%

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Comparison of Fentanyl and Halothane as Supplement to Nitrous‐Oxide‐Oxygen Anaesthesia for Coronary Artery Surgery

Fischerström

Öhqvist

Settergren

1985

Acta Anaesthesiol Scand

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Twenty unselected patients suffering from incapacitating angina, in spite of medication with nitrates, beta-blockers and calcium antagonists, were studied before and during coronary artery bypass surgery. Fentanyl or halothane was randomly used in combination with nitrous oxide for maintenance of anaesthesia in order to compare the haemodynamic response to surgery and cardiopulmonary bypass with these two anaesthetic regimens. Systemic and pulmonary artery pressure were kept within normal limits with the aid of volume replacement and/or nitroprusside. The haemodynamic response to surgery and bypass was benign and almost identical in the two groups. Cardiac index increased markedly after bypass (P less than 0.02-0.001) from 2.0 to 3.0 1 X min-1 X m-2 due to an increase in heart rate with no change in stroke index (40 ml X m-2). Oxygen delivery remained unchanged at 17 mmol X min-1 X m-2 in spite of a marked reduction in blood erythrocyte volume fraction (B-EVF), from 38% before bypass to 24% after bypass (P less than 0.001). Oxygen uptake remained unchanged until the end of surgery and did not differ between the groups. Systemic vascular resistance, corrected for the change in viscosity due to the altered B-EVF, was unchanged during the study. No difference was observed between the groups in the relation between pulmonary artery diastolic pressure and left ventricular stroke work index or stroke index, either before or at the end of cardiopulmonary bypass when the patients were transfused from the oxygenator.

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“…The reported incidence of unintended awareness in cardiac practice ranges from less than 1% to over 20%, depending on the definition of awareness, the size of the study and the method of detection ( Table 1). The early studies [6][7][8] included fewer than 60 patients each, so were subject to sampling error, and were carried out during the era of highdose opioid anaesthesia. The later studies were prospective, used a balanced anaesthesia technique, and included 600-900 patients, finding an incidence of 0.3-1.14% [11][12][13].…”

Section: Editorialmentioning

confidence: 99%