Propofol for direct current cardioversion in cardiac risk patients.

We investigated 69 patients (most belonging to NYHA classes II and III) undergoing elective direct current cardioversion of atrial fibrillation (46 patients) and atrial flutter (23 patients), respectively. Without premedication anaesthesia was induced with the new soya bean emulsion of propofol ('Diprivan') 1.2 mg.kg-1 over 45 s. Recovery time was measured from the start of the anaesthetic injection to the moment at which the patients regained consciousness. Completeness of recovery was assessed with two methods: opening eyes on command and time orientation. Good amnesia was observed in all patients. Conversion was achieved in all but seven patients (90%). After injection of propofol, the mean arterial pressure decreased slightly (2% below baseline). Induction of anaesthesia and successful DCC effected a statistically significant decrease in both the heart rate and the rate pressure product. Eleven patients required assisted ventilation for 2 min due to respiratory depression. Fifteen patients developed arrhythmias. Side-effects, such as myocloni, recall or vomiting, were not observed. In conclusion, propofol may well prove to be the anaesthetic of choice for DCC in cardiac patients because of good amnesia, low incidence of side-effects and short recovery time (mean 5.3 min).