Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil

Poterman, Marieke; Scheeren, Thomas; Velde, M.I. van der; Buisman, Pieter; Allaert, Silvie; Struys, Michel; Kalmar, Alain

doi:10.1097/eja.0000000000000639

Cited by 20 publications

(14 citation statements)

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“…Compared to other opioids, remifentanil evokes a dose dependent prolongation of the cardiac conduction times (by influencing the sinus and atrioventricular node and intra-atrial conduction), inhibition of sinoatrial automaticity and vagally mediated inotropic effects [ 7 , 32 ]. In accordance with previous observations, we expected more distinct positive effects of atropine on the haemodynamic variables and tissue oxygenation during remifentanil based anaesthesia [ 12 ]. However, in our previous study from non-cardiac surgery, none of the patients were on beta-blocking agents, as opposed to the 90% in both of the groups of the current study, which exclusively included patients with ischemic heart disease.…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, patients in the remifentanil group demonstrated lower SctO 2 values. During induction of anaesthesia, a raised inspired oxygen fraction combined with general vasodilation results in an overall increased tissue oxygenation [12]. Despite this, the more pronounced haemodynamic suppression in the remifentanil group led to lower SctO 2 values than in the sufentanil group.…”

Section: Discussionmentioning

confidence: 97%

“…After the induction of anaesthesia with comparable doses of opioids, remifentanil did not only cause a more evident decrease in HR, but also in SV. Remifentanil is well known for its direct bradycardic effects, especially compared to other opioids, but not for the negative effect on SV [ 6 , 12 ]. As a result of a decreased HR, an increase in SV would typically be expected, due to a longer diastolic filling time.…”

Section: Discussionmentioning

confidence: 99%

“…Beneficial effects of atropine, not only on MAP and HR, but also on CI during propofol-remifentanil anaesthesia in patients undergoing non-cardiac surgery have been reported [12]. However, this may not be equally valid during anaesthesia with propofol combined with other opioids, such as sufentanil, and in patients undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 97%

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Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

et al. 2020

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Background Balanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia. Methods In seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 μg ml− 1 and either sufentanil (TCI Cet 0.48 ng ml− 1) or remifentanil (TCI Cet 8 ng ml− 1). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO2) and peripheral (SptO2) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed. Results The sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = − 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = − 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = − 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = − 0.8 (− 1.5 to − 0.5) vs. -1.5 (− 2.0 to − 1.1) l min− 1 m− 2), while SctO2 (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO2 (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min− 1 m− 2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO2 and ∆SptO2. Conclusion Induction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO2 compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids. Trial registration Clinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

et al. 2020

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“…Secondly, the patients were rather volume dependent due to the combination of vasoplegia by epidural analgesia and hypovolemia by bowel preparation, which may explain the distinct effects observed in this study, compared to other reports. Thirdly, atropine was administered at the start of anesthesia to attenuate the negative effects on the MAP and CO after induction with TIVA [ 24 ]. This doesn’t influence the effects of phenylephrine on the venous return, but it probably blunts the reflex bradycardia induced by phenylephrine.…”

Section: Discussionmentioning

confidence: 99%

Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension

Kalmar

Allaert

Pletinckx

et al. 2018

J Clin Monit Comput

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Induction of general anesthesia frequently induces arterial hypotension, which is often treated with a vasopressor, such as phenylephrine. As a pure α-agonist, phenylephrine is conventionally considered to solely induce arterial vasoconstriction and thus increase cardiac afterload but not cardiac preload. In specific circumstances, however, phenylephrine may also contribute to an increase in venous return and thus cardiac output (CO). The aim of this study is to describe the initial time course of the effects of phenylephrine on various hemodynamic variables and to evaluate the ability of advanced hemodynamic monitoring to quantify these changes through different hemodynamic variables. In 24 patients, after induction of anesthesia, during the period before surgical stimulus, phenylephrine 2 µg kg−1 was administered when the MAP dropped below 80% of the awake state baseline value for > 3 min. The mean arterial blood pressure (MAP), heart rate (HR), end-tidal CO2 (EtCO2), central venous pressure (CVP), stroke volume (SV), CO, pulse pressure variation (PPV), stroke volume variation (SVV) and systemic vascular resistance (SVR) were recorded continuously. The values at the moment before administration of phenylephrine and 5(T5) and 10(T10) min thereafter were compared. After phenylephrine, the mean(SD) MAP, SV, CO, CVP and EtCO2 increased by 34(13) mmHg, 11(9) mL, 1.02(0.74) L min−1, 3(2.6) mmHg and 4.0(1.6) mmHg at T5 respectively, while both dynamic preload variables decreased: PPV dropped from 20% at baseline to 9% at T5 and to 13% at T10 and SVV from 19 to 11 and 14%, respectively. Initially, the increase in MAP was perfectly aligned with the increase in SVR, until 150 s after the initial increase in MAP, when both curves started to dissociate. The dissociation of the evolution of MAP and SVR, together with the changes in PPV, CVP, EtCO2 and CO indicate that in patients with anesthesia-induced hypotension, phenylephrine increases the CO by virtue of an increase in cardiac preload.

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Comparison between hemodynamic effects of propofol and thiopental during general anesthesia induction with remifentanil infusion: a double-blind, age-stratified, randomized study

et al. 2019

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Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil

Abstract: Clinicaltrials.gov identifier: NCT01871922.

Cited by 20 publications

References 27 publications

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension

Comparison between hemodynamic effects of propofol and thiopental during general anesthesia induction with remifentanil infusion: a double-blind, age-stratified, randomized study

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