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Titolo:
MYOCARDIAL-ISCHEMIA DURING INDUCTION OF A NESTHESIA IN PATIENTS WITH CHRONIC CORONARY-ARTERY DISEASE - A COMPARISON OF PROPOFOL, ETOMIDATE,AND MIDAZOLAM
Autore:
LISCHKE V; PROBST S; BEHNE M; KESSLER P;
Indirizzi:
UNIV FRANKFURT,ZENTRUM ANAESTHESIOL & WIEDERBELBUNG,THEODOR STERN KAI7 D-60596 FRANKFURT GERMANY
Titolo Testata:
Anasthesist
fascicolo: 7, volume: 42, anno: 1993,
pagine: 435 - 440
SICI:
0003-2417(1993)42:7<435:MDIOAN>2.0.ZU;2-H
Fonte:
ISI
Lingua:
GER
Soggetto:
LEFT-VENTRICULAR FUNCTION; FENTANYL ANESTHESIA; HEMODYNAMIC-RESPONSES; BYPASS-SURGERY; DOSE FENTANYL; PANCURONIUM; ISCHEMIA; THIOPENTONE; VECURONIUM; METABOLISM;
Keywords:
MYOCARDIAL ISCHEMIA; ST-SEGMENT; AORTOCORONARY BYPASS GRAFTING; PROPOFOL; MIDAZOLAM; ETOMIDATE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
31
Recensione:
Indirizzi per estratti:
Citazione:
V. Lischke et al., "MYOCARDIAL-ISCHEMIA DURING INDUCTION OF A NESTHESIA IN PATIENTS WITH CHRONIC CORONARY-ARTERY DISEASE - A COMPARISON OF PROPOFOL, ETOMIDATE,AND MIDAZOLAM", Anasthesist, 42(7), 1993, pp. 435-440

Abstract

Induction of anaesthesia with propofol and fentanyl can lead to marked reductions in mean arterial pressure (MAP) and heart rate (HR). Thus, the application of propofol in patients with severely reduced coronary artery perfusion is controversial. Methods. The study group consisted of 60 patients undergoing coronary artery bypass grafting (CABG). Anaesthesia was induced over 30 s with propofol (P 1.5 mg/kg), etomidate (E 0.3 mg/kg), or midazolam (M 0.15 mg/kg) following a bolus dose offentanyl (5 mug/kg). Vecuronium was used as a muscle relaxant. Duringinduction we continuously measured MAP and HR and recorded the occurrence of myocardial ischaemia using an automatic ST-segment analyser (Marquette 7010). ST-segment deviations of more than 1 mm in leads II and V5 were interpreted as significant signs of myocardial ischaemia. Results. All groups showed reductions in MAP and HR on induction that were marked in the P group. Intubation caused elevation of MAP and HR topre-induction levels (HR: all groups) or slightly above (MAP: E, M). Four patients in the P group and 3 in each other group showed significant ST-segment deviation prior to induction. In the P group these deviations disappeared in 2 patients after injection while they remained unchanged in the M group. In the E group injection had no effect on theischaemic ECG changes but produced another case of significant ST-segment deviation. Laryngoscopy and intubation produced no further significant ST-segment deviation in either group. Discussion. Induction is acritical phase of anaesthesia, especially in patients with limited coronary reserve. Induction agents should alleviate the stress response while causing minimal - haemodynamic changes. Despite marked reductions in MAP in the P group, the number of patients with ischaemic ECG changes was cut by half. Their number was unchanged or even raised in theother groups. After application of P, with an alleged reduction of coronary perfusion, a compensational reduction in myocardial oxygen consumption may occur.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/09/20 alle ore 19:54:44