The use of etomidate infusions during anaesthesia for cardiopulmonary bypass

Oduro, A.; Tomlinson, A. A.; Voice, A.; Davies, GE

doi:10.1111/j.1365-2044.1983.tb15183.x

Cited by 13 publications

(6 citation statements)

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“…We do not know yet whether the results of the present study apply to other anaesthetic regimens or whether they are restricted to the combination studied (propofol±sufentanil). Indeed, propofol concentrations have been reported to be unchanged [19] whereas etomidate concentrations fell upon initiation of CPB [20]. In conclusion, the results of the present study indicate that the hypnotic component of anaesthesia as estimated by the BIS does not change upon initiation and during normothermic cardiopulmonary bypass.…”

Section: Possible Clinical Implications Of the Present Studysupporting

confidence: 50%

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Effects of normothermic cardiopulmonary bypass on bispectral index

2000

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This study investigated the changes in the hypnotic component of anaesthesia, estimated by the bispectral index of the electroencephalogram, during normothermic cardiopulmonary bypass. Twenty-six patients (20 men, 6 women), aged 61 +/- 11 years (Mean +/- SD) scheduled for cardiac surgery were premedicated with hydroxyzine and meperidine. Anaesthesia was induced and maintained with a computer-controlled continuous infusion (not adjusted for haemodilution) of sufentanil (effect site concentration 0.4-0.6 ng mL-1) and a manually adjusted continuous infusion of propofol (4.4 +/- 1.8 mg kg-1 h-1). Cardiopulmonary bypass was normothermic with moderate haemodilution. Bispectral index was measured with a referential montage before, 30 s, 1, and 3 min after cardiopulmonary bypass onset, before and after aortic cross-clamping, 30 min after cardiopulmonary bypass onset, before and after aorta cross-clamp release and before and after weaning from cardiopulmonary bypass. Bispectral index values were 48 +/- 8 before cardiopulmonary bypass onset, 50 +/- 10 before, and 48 +/- 8 after end of cardiopulmonary bypass (P = NS). No patient had increases in bispectral index values during cardiopulmonary bypass consistent with awakening. We conclude that with the anaesthetic regimen presented in this study bispectral index values do not change during normothermic cardiopulmonary bypass.

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Section: Possible Clinical Implications Of the Present Studysupporting

confidence: 50%

“…We do not know yet whether the results of the present study apply to other anaesthetic regimens or whether they are restricted to the combination studied (propofol–sufentanil). Indeed, propofol concentrations have been reported to be unchanged [19] whereas etomidate concentrations fell upon initiation of CPB [20].…”

Section: Discussionmentioning

confidence: 99%

Effects of normothermic cardiopulmonary bypass on bispectral index

2000

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“…Hypothermia to a nasopharyngeal temperature between 25°C and 27°C was induced with an in-circuit heat exchanger. (17) 101 (8) 11 3 (20) 114 (13) 125 (14) Mean arterial pressure (mmHg) 80 (12) 68 (3) 77 (11) 80 (11) 84 (13) Diastolic arterial pressure (mmHg) 63 (11) 52 13) 60 (8) 63 (11) 61 (12) sq m body surface area was maintained during normothermia but reduced to 1.81 litres/minute/sq m during hypothermia. Measurements of heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), were measured in the awake state, after tracheal intubation and after sternotomy using a transducer calibrated against a mercury manometer.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Propofol—fentanyl anaesthesia for coronary artery surgery and cardiopulmonary bypass

Russell¹,

Wright²,

Fox³

et al. 1989

Anaesthesia

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SummaryA two-stage propofol infusion combined with fentanyl was w e d to maintain anaesthesia during coronary artery surgery in patients with good ventricular function. Whole blood propojol concentrations were measured at frequent intervals; plasma protein binding was measured before, during and after cardiopulmonary bypass. An initial infusion rate of 10 mg/kg/hour provided good protection from the pressor response to sternotomy. A predictable steady state concentration was achieved in the prebypass period with a maintenance infusion rate of 3 mglkglhour. The onset of bypass resulted in a small decrease in propofol concentration as a result of haemodilution. Induced hypothermia resulted in an increase in propofol concentration which returned rapidly to the prebypass steady state value during rewarming. The free propofol fraction increased during cardiopulmonary bypass. No patient had any recall of operative events or required inotropic support during weaning from bypass. Key wordsAnaesthesia; cardiovascular. Anaesthetics, intravenous; propofol.Propofol, a new intravenous anaesthetic agent, is suitable for maintenance of anaesthesia by infusion. It has been used recently for coronary artery surgery performed during cardiopulmonary bypass (CPB).1*2 Hypothermic CPB causes many physiological changes which have clinically significant effects on the disposition and elimination of drugs.3 This study was designed to assess the suitability of a two-stage propofol infusion for cardiac surgery and in particular to study the effect of hypothermic CPB on the kinetics of the drug. MethodsThe study received institutional ethics approval and each patient gave written informed consent. Ten male patients were studied; all were scheduled for coronary artery surgery with internal mammary artery anastomosis to the left anterior descending coronary artery. All had good or only moderately impaired ventricular function as defined by an ejection fraction of approximately 50%. All were receiving maintenance doses of a beta-adrenoceptor antagonist (metoprolol or atenolol), a calcium antagonist (nifedipine) and a nitrate (isosorbide dinitrate or glyceryl trinitrate). These drugs were continued up to and including the morning of operation.Premedication consisted of sodium amylobarbitone 300 mg on the evening before operation and diazepam 1 6 1 5 mg one hour before operation. Radial artery pressure monitoring was established under local anaesthesia. Electrocardiographic (ECG) monitoring was applied and lead 11 displayed continuously. Anaesthesia was induced with fentanyl 25 pg/kg, diazepam 0.1 mg/kg -and pancuronium 0.15 mg/kg, and the lungs were ventilated with oxygen-enriched air to normocapnia. An infusion of propofol at the rate of 10 mg/kg/hour was established through a dedicated peripheral arm vein 10 minutes before skin incision and continued for 15-20 minutes during which time sternotomy and sternal spread were performed. The infusion was then reduced to a maintenance rate of 3 mg/kg/hour until the final skin suture had been inserte...

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“…References for data presented in the fig. : Propofol ( 36) ( 38) ( 35), Etomidate ( 41), Thiopentone ( 43), Methohexitone ( 7), Ketamine ( 45), Lorazepam ( 52), Midazolam ( 56) ( 33), Propranolol ( 96) ( 95), Digoxin ( 102) ( 103), Diltiazem ( 99), Lidocaine ( 88) ( 90).…”

Section: Effect Of Cardiopulmonary Bypass On the Pharmacokinetics Of unclassified

The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass

Mets

2000

Acta Anaesthesiol Scand

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The institution of cardiopulmonary bypass during cardiac surgery has profound effects on the plasma concentration of drugs and thus their therapeutic effectiveness. These changes occur through acute hemodilution, altered plasma protein binding, hypotension, as well as the use of hypothermia and heparin administration. Isolation of the lungs from the circulation and the possible sequestration of drugs in the bypass circuit also affect drug plasma concentrations on bypass. The individual characteristics of the drug in question are also important in determining the final plasma concentration: Lipid soluble drugs with a high volume of distribution may be more readily taken up by bypass equipment, but the initial fall in concentration at the start of cardiopulmonary bypass may be more readily counteracted by back diffusion into plasma, if large tissue stores have accumulated. The extent of the drug's plasma protein binding is of importance as the effective free fraction in plasma for highly bound drugs will be sensitive to changes in plasma protein binding brought on by factors such as hemodilution, heparin administration as well as alpha, acid-glycoprotein binding. Clearly the fate of drugs administered before or on bypass is complex and can only be accurately determined by specific studies evaluating drug plasma concentrations. This review updates the available data on anesthetics and drugs used during cardiac surgery in order that anesthetists may predict better the likely effect of drugs administered before or during cardiopulmonary bypass.

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The use of etomidate infusions during anaesthesia for cardiopulmonary bypass

Cited by 13 publications

References 1 publication

Effects of normothermic cardiopulmonary bypass on bispectral index

Effects of normothermic cardiopulmonary bypass on bispectral index

Propofol—fentanyl anaesthesia for coronary artery surgery and cardiopulmonary bypass

The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass

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