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Left Ventricular Function during Propofol and Fentanyl Anesthesia in Patients with Coronary Artery Disease

Assessment with a Radionuclide Approach

Département d'Anesthésie-Réanimation Chirurgicale et Service de Médecine Nucléaire, Hotel-Dieu, Centre Hospitalier Universitaire, Nantes, France, and the Service Pharmaceutique, Centre Hospitalier Universitaire Xavier Bichat, Paris, France.

Abstract

Using gated radionuclide ventriculography and invasive cardiac monitoring, the effects of propofol alone and in combination with fentanyl on left ventricular (LV) volumes and function were investigated in 10 ASA III, unpremedicated patients (51–75 years) with coronary artery disease (NYHA II-III). Anesthesia was induced with propofol (2 mg/kg) followed by an infusion (100 µg-kg¹min^–1). Vecuronium (0.05 mg/kg) was administered and ventilation (FiO₂, 1.0) was manually controlled via a face mask (FECO₂, 4–5%). Data acquisitions were serially obtained over 15 minutes after the bolus IV injection of propofol and 5 minutes after the injection of fentanyl (5 µg/kg). Propofol induced a rapid decrease (15%) in mean arterial pressure (MAP) exclusively related to a decrease in cardiac index (CI), without reduction in indexed systemic, vascular resistances (SVRI). Despite the decrease in MAP, heart rate did not change. The decrease in CI was associated with a lower preload. After the addition of fentanyl, MAP decreased significantly (35%) below the last set of propofol measurements. The decrease in MAP was associated with a reduction in CI and SVRI. Fentanyl was also associated with a significant decrease in heart rate (16%) resulting in a decrease in CI, whereas stroke index and end diastolic volume did not change. Neither global ejection fraction (EF) nor end systolic volume changed significantly at any time, nor were there changes in the ECG or in regional ejection fractions (REF). The absence of changes in REF was consistent with lack of wall motion abnormalities of the left ventricle. Propofol alone and in combination with fentanyl does not alter LV performance in patients with good LV function. However, the magnitude of MAP reduction might jeopardize coronary perfusion in severe ischemic heart disease.

Key Words: ANALGESICS—fentanyl. • ANESTHETICS, INTRAVENOUS—propofol. • HEART—myocardial function, anesthetics. • MEASUREMENT TECHNIQUES—cardiac output, radioactive tracers.

This article has been cited by other articles:

				P. F. Wouters, M. Van de Velde, and J. Van Hemelrijck Cardiovascular Effects of Propofol Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1997; 1(2): 121 - 131. [PDF]

				J. D. Swenson and P. L. Bailey Opioids in Cardiovascular Anesthesia Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1997; 1(2): 146 - 163. [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999