López RSE, Rojas PEM, Guillén RR, Añorve RI, Mikolajczuk JJA, Chávez CA

Language: Spanish
References: 11
Page: 124-128
PDF size: 309.76 Kb.

ABSTRACT

Objective: To observe the influence of anesthetic induction with fentanyl, etomidate, rocuronium and maintenance with sevoflurane at one minimum alveolar concentration on cardiac power. Methods: 16 awake patients were monitored under local anesthesia for cardiac surgery. We recorded hemodynamic variables and cardiac power, preinduction, postinduction, one minimum alveolar concentration of sevoflurane and after the surgical procedure. The hemodynamic variables and cardiac power were analyzed with Hotelling’s T² to observe changes over time and t-Student test for related samples. Results: There were changes over time in heart rate (p = 0.007), mean arterial pressure (p = 0.0001), cardiac output (p = 0.0001), cardiac index (p = 0.0001), work index of left ventricle (p = 0.003) and cardiac power (p = 0.0001). Postinduction mean arterial pressure decreased (p = 0.0001), 22%, cardiac output (p = 0.01), 22%, cardiac index (p = 0.006), 22%, work index of left ventricular (p = 0.001), 46% and cardiac power (p = 0.001), 42%. At the end of surgery, the mean arterial pressure (p = 0.0001) and rate of left ventricular work (p = 0.013) decreased compared to baseline. Conclusion: The cardiac power decreases after induction of anesthesia and at one minimum alveolar concentration of sevoflurane don’t decrease anymore.

REFERENCES

1. Cotter G, Williams SG, Vered Z, Tan LB. Role of cardiac power in heart failure. Curr Opin Cardiol 2003; 18: 215-222.

2. Esquivel C, Chávez L, García G, Ramírez J, Oyervides V, García I, Camacho R. Poder cardiaco como marcador pronóstico en choque cardiogénico en infarto agudo de miocardio. Med Int Mex 2009; 25: 263-269.

3. Holmes DR, Bates ER, Kleiman NS. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. J Am Coll Cardiol 1995; 26: 668-674.

4. Kurl S, Laukkanen J, Niskanen L. Cardiac power during exercise and the risk of stroke in men. Stroke 2005; 36: 820-824.

5. Armstrong G, Carlier S, Fukamachi K, Thomas J, Marwick T. Estimation of cardiac reserve by peak power: validation and initial application of a simplified index. Heart 1999; 82: 357-364.

6. Tan LB. Evaluation of cardiac dysfunction, cardiac reserve and inotropic response. Postgrad Med J 1991; 67: S10-20.

7. Tan LB. Clinical and research implications of new concepts in the assessment of cardiac pumping performance in heart failure. Cardiovasc Res 1987; 21: 615-622.

8. Moreno MA, Lozano R, González MA, Hernández AE. Etomidato como inductor anestésico en cirugía de corazón abierto. Rev Mex Anest 1984; 7: 381-386.

9. Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK Trial Registry. J Am Coll Cardiol 2004; 44: 340-348.

10. Tan LB. Cardiac pumping capability and prognosis in heart failure. Lancet 1987; 328: 1360-1363.

11. Miller R, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 7ª Ed. Philadelphia, PA: Churchill Livingstone Elservier; 2010.