[Comparative hemodynamic study of anesthesia induction with propofol (Diprivan), thiopental, methohexital, etomidate and midazolam in patients with coronary disease].

UNLABELLED

In patients undergoing cardiac surgery, the induction of anesthesia is not without risk because of specific cardiovascular effects of the anesthetic and the preoperative state of the patient. The hemodynamic effects of etomidate, midazolam, thiopental, and methohexital are well known: etomidate is an anesthetic that induces only minor cardiovascular changes; its influence on the endocrine system, however, has reduced its clinical indication. Barbiturates such as thiopental and methohexital produce negative inotropic effects in combination with an increase in heart rate and myocardial oxygen consumption; midazolam reduces pre- and afterload in patients with poor left ventricular function. Propofol, a new short-acting induction agent with good anesthetic properties, is said to diminish arterial pressure as well as myocardial oxygen consumption.

METHODS

In a randomized study we investigated the hemodynamic effects of intravenous induction with propofol (2 mg/kg body wt.), thiopental (5 mg/kg), methohexital (1 mg/kg), etomidate (0.3 mg/kg), and midazolam (0.15 mg/kg) in 50 patients undergoing coronary artery bypass grafting. All patients were premedicated with flunitrazepam (0.03 mg/kg up to 2 mg) and morphine hydrochloride (0.2 mg/kg up to 15 mg) 100 min before the investigation. After 0.003 mg/kg fentanyl the patients received the induction agent in the above-mentioned dosage within 40 s followed by 0.1 mg/kg pancuronium bromide. Hemodynamic measurements were performed 1, 3, and 5 min after the end of the injection as well as 1 and 5 min after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)