Right ventricular end-systolic pressure-volume relation during propofol infusion

Martin, C. J.; Saux, P.; Albanèse, Jacques; B, Eon

doi:10.1097/00000542-198809010-00014

Cited by 9 publications

(8 citation statements)

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“…This raised the concern that propofol may impair RV function. Laboratory studies have shown propofol to have negative inotropic effects, 20 -22 and one clinical study 23 of sedation with propofol in the ICU showed decreased RV end-systolic pressure -volume relation -an index of contractility.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia

Gouvêa

Díaz

Auler

et al. 2008

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia

Gouvêa

Díaz

Auler

et al. 2008

British Journal of Anaesthesia

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“…Ketamine increases pulmonary vascular resistance in adults [52], although this has not been observed in children [53]. Propofol sedation in patients with acute respiratory failure or neurological disease receiving critical care was found to decrease right ventricular contractility and this effect was reversed by dobutamine [54]. Interestingly, in a comparison study of propofol and isoflurane in patients undergoing one-lung ventilation, there was a greater reduction in the mean cardiac index and right ventricular ejection fraction with propofol, but propofol was not associated with a significant increase in shunt fraction, whereas isoflurane was associated with a three-fold increase in shunt fraction [55].…”

Section: Principles Of Anaesthetic Managementmentioning

confidence: 98%

“…During induction of general anaesthesia, there is a period of susceptibility until the airway is secured and ventilation controlled. An adequate depth of anaesthesia should be ensured before attempting laryngoscopy and tracheal intubation, as sympathetic stimulation has deleterious Table 7 Effect of anaesthetic agents on right ventricular (RV) contractility and pulmonary vascular resistance [46][47][48][49][50][51][52][53][54][55][56][57].…”

Section: Airway and Ventilationmentioning

confidence: 99%

Pulmonary hypertension and its management in patients undergoing non‐cardiac surgery

2014

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SummaryPulmonary hypertension is a complex disorder of the pulmonary vasculature that leads to increased peri-operative morbidity and mortality. Non-cardiac surgery constitutes a significant risk in patients with pulmonary hypertension. The management of right ventricular failure is inherently challenging and fraught with life-threatening consequences. A thorough understanding of the pathophysiology, the severity of the disease and its treatment modalities is required to deliver optimal peri-operative care. This review provides an evidence-based overview of the definition, classification, pathophysiology, diagnosis and treatment of pulmonary hypertension and focuses on the peri-operative management and treatment of pulmonary hypertensive crises in a non-cardiac setting.

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“…In addition to the effect of mechanical ventilation, right ventricular function can be altered by hemodynamic changes, as well as the direct negative effects of anesthesia agents on right ventricular myocardial contractility. Propofol, for example, has been shown to alter systemic hemodynamic parameters without influencing the RVEDV or RVEF, measured by pulmonary artery catheter-based techniques (24,25). Midazolam, the sedative agent used in this study, is known to have little to no impact on pulmonary vascular resistance 5 minutes after anesthesia induction, but can reduce both the left-and right-ventricular stroke work indices (26,27).…”

Section: Observer Variabilitymentioning

confidence: 88%

The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: An echocardiography-based prospective observational study

Magunia¹,

Jordanow

Keller

et al. 2019

Preprint

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Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: After anesthesia induction TAPSE (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (RVEF; p=0.1607) and right ventricular stroke volume (RVSV; p=0.1838) did not change. Conclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration: Retrospecitvely registered, 6 th June 2016, ClinicalTrials.gov Identifier NCT02820727.

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Right ventricular end-systolic pressure-volume relation during propofol infusion

Cited by 9 publications

References 0 publications

Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia

Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia

Pulmonary hypertension and its management in patients undergoing non‐cardiac surgery

The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: An echocardiography-based prospective observational study

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