TITLE

Effects of the combinations propofol/alfentanil and midazolam/fentanyl on blood pressure and contact phase system during coronary surgery

AUTHOR(S)
Schulze, H-J.; Wendel, H.P.; Kleinhans, M.; Oehmichen, S.; Heller, W.; Hoffmeister, H-E.
PUB. DATE
September 1998
SOURCE
Perfusion;1998, Vol. 13 Issue 5, p338
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Perioperative haemodynamic changes leading to severe circulatory problems during open-heart surgery still represent dreaded complications. The aim of this study was to examine the relationship between the use of applied anaesthetic agents and alterations of the contact phase of the intrinsic blood-clotting system, as changes within the kallikreinkinin system can lead to a fall in blood pressure. In a randomized study, parameters of the kallikreinkinin system, coagulation and fibrinolysis were determined for 36 patients with aortocoronary bypass operations. The patients had been given either midazolam/fentanyl or propofol/alfentanil to maintain anaesthesia. Perioperative blood pressure values were registered at seven fixed points. The measured values of the factor XIIa-like activity and the kallikrein-like activity suggested a higher activation of the contact phase, when propofol/alfentanil was given. From the start of the extracorporeal circulation (ECC) to the end of the operation, the kallikrein-like activities in the propofol/alfentanil group were significantly higher than those of the midazolam/fentanyl group. Also, the results of the kallikrein inhibition capacity and the indicators of fibrinolysis (t-PA and d-dimers) indicate a stronger activation of the contact phase at least at the beginning of recirculation and as a result of it, a stronger fibrinolysis within the propofol/alfentanil group. In addition, the hypotensive side-effects differed significantly between the two groups. Patients receiving propofol/alfentanil needed the triple amount of anti-hypotonicum to maintain the mean arterial blood pressure above 75 mmHg. With the results of this study, a correlation between the application of propofol/alfentanil, contact phase activation, with activation of the kallikreinkininbradykinin system and the observed hypotension, can be presumed.
ACCESSION #
4093518

 

Related Articles

  • Cybertools improve reaction time in open heart surgery Beuchat, Antoine; Taub, Steven; Saby, Jean-Damien; Dierick, Vincent; Codeluppi, Gianmarco; Corno, Antonio F.; von Segesser, Ludwig K. // European Journal of Cardio-Thoracic Surgery;Feb2005, Vol. 27 Issue 2, p266 

    Abstract: Objective: Head-up displays allow the surgeons to simultaneously view the patient and the patient''s vital parameters (ECG, blood pressure, etc.) using vision-through over a wireless net, potentially enhancing the speed, accuracy and safety of surgical decisions. The aim was to assess...

  • Autonomic Characteristics Following Surgical Repair of Tetralogy of Fallot Using Heart Rate and Blood Pressure Variability. Perrault, Hélène; Tzovanis, Maria; Johnson, Dominique; Davignon, André; Chartrand, Claude; Mokrane, Abdelkader; Nadeau, Réginald A. // Pediatric Exercise Science;Feb2001, Vol. 13 Issue 1, p47 

    Compares the autonomic responses of adolescents operated for tetralogy of Fallot in early childhood. Assessment of the electrocardiograph and blood pressure obtained during spontaneous and controlled respiration; Verification on the incidence of complete cardiac vagal activity; Elaboration of...

  • Hemodynamics in off-pump surgery: normal versus compromised preoperative left ventricular function. Fiore, Giuseppe; Latrofa, Maria Elena; Tunzi, Pasquale; Traversa, Maria; Fondacone, Corrado; Marraudino, Nicola; de Luca Tupputi Schinosa, Luigi; Fiore, Tommaso // European Journal of Cardio-Thoracic Surgery;Mar2005, Vol. 27 Issue 3, p488 

    Abstract: Objective: Off-pump coronary surgery (OPCABG), avoiding cardiopulmonary bypass and cardioplegic arrest, seems to be a better choice in patients with poor baseline cardiac function. Since cardiocirculatory collapse could be induced by heart displacement in this group of patients at high...

  • Eptacog-α.  // Reactions Weekly;11/3/2007, Issue 1176, p13 

    The article describes the case of a woman who experienced bleeding during cardiac surgery and has developed clotting in all her cardiac chambers after the administration of eptacog-α. The woman developed electromechanical dissociation with no detectable blood pressure (BP) and was started...

  • First experiences with intraoperative Levosimendan in pediatric cardiac surgery. Osthaus, Wilhelm Alexander; Boethig, Dietmar; Winterhalter, Michael; Huber, Dirk; Goerler, Heidi; Sasse, Michael; Sümpelmann, Robert; Sümpelmann, Robert // European Journal of Pediatrics;Jun2009, Vol. 168 Issue 6, p735 

    Levosimendan is a calcium-sensitizing agent with effective inotropic properties. It has been shown to improve cardiac function, hemodynamic performance, and survival in adults with severe heart failure. However, the effect of Levosimendan in pediatric cardiac surgery has not yet been...

  • Cardiac output measurement by pulse dye densitometry: a comparison with the Fick's principle and thermodilution method. Bremer, Frank; Schiele, Albert; Tschaikowsky, Klaus // Intensive Care Medicine;Apr2002, Vol. 28 Issue 4, p399 

    Objective: To evaluate the agreement between cardiac output (CO) measurements obtained by a new dye dilution technique using pulse dye densitometry (PDD) and thermodilution (TD) and the direct Fick method (F). Design and setting: Prospective clinical study in a university hospital, cardiac...

  • Anethesia-related hypotension in a small-animal practice. Gordon, Andrea M.; Wagner, Ann E. // Veterinary Medicine;Jan2006, Vol. 101 Issue 1, p22 

    The article presents a study that examines the occurrence of hypotension in dogs and cats anesthetized in a private veterinary practice. In this paper, the concept of hypotension is defined. The article also presents the procedures for which anesthesia was indicated. Moreover, the factors that...

  • Is a combination of Isoflurane with nitroglycerine better than halothane with nitroglycerine for controlled hypotension in spine surgery: A comparative clinical evaluation? Jindal, Parul; Gupta, Rohit; Sharma, J. P. // Internet Journal of Anesthesiology;2008, Vol. 17 Issue 1, p7 

    Methods and techniques for producing deliberate hypotension has been changing continuously and evolving, not only as the result of the discovery of newer agents and techniques but also from an improved understanding of the underlying physiological changes. This study was conducted at Himalayan...

  • Description of a technique for anaesthetizing pregnant ewes for fetal surgery . V.L. Webster; D.M. Cara; R.M. Walker; M.M. Ramsay; A.R. Aitkenhead // Laboratory Animals;Jan2005, Vol. 39 Issue 1, p94 

    General anaesthesia in 12 pregnant ewes undergoing surgery for fetal physiological research was supplemented with an intravenous infusion of remifentanil. This allowed us to employ a lighter plane of surgical anaesthesia and to use intermittent positive pressure ventilation. Our aim was to...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics