A. Ducart

Propofol-alfentanil versus fentanyl-midazolam in coronary artery surgery.

OBJECTIVEnTo compare intraoperative hemodynamics profiles and recovery characteristics of propofol-alfentanil with fentanyl-midazolam anesthesia in elective coronary artery surgery.nnnDESIGNnProspective, randomized study.nnnSETTINGnUniversity hospital.nnnPARTICIPANTSnFifty patients with impaired or good left ventricular function.nnnINTERVENTIONSnIn group 1, (n = 25) anesthesia was induced with an infusion of propofol, 3 to 4 mg/kg/h, alfentanil, 500 micrograms, and pancuronium 0.1 mg/kg, and maintained with propofol, 3 to 6 mg/kg/h (variable rate), and alfentanil infusions, 30 micrograms/kg/h (fixed rate). Additional boluses of alfentanil, 1 mg, were administered before noxious stimuli; group 2 (n = 25) received a loading dose of fentanyl, 25 micrograms/kg, midazolam, 1.5 to 3 mg, and pancuronium, 0.1 mg/kg for induction, followed by an infusion of fentanyl, 7 micrograms/kg/h, for maintenance. Additional boluses of midazolam (1.5 to 3 mg) and fentanyl (250 micrograms) were administered before noxious stimuli. MEASUREMENTS AND MAIN RESULTS. Cardiovascular parameters at eight intraoperative time points as well as time to extubation, morphine consumption, and pain scores were recorded. Induction of anesthesia was associated in both groups with a small but significant decrease in mean arterial pressure (1: 15 mmHg (15%); 2: 8 mmHg (8%) with significant decreases in cardiac index (1: 8%; 2: 8%) and left ventricular stroke work index (1: 24%; 2: 21%). Throughout surgery, hemodynamic profiles were comparable between groups except after intubation when the MAP was significantly lower in group 1 (75 +/- 12 mmHg) than in group 2 (89 +/- 17 mmHg). Group 1 required less inotropic support. Extubation was performed faster in group 1 (7.6 h) than in group 2 (18.0 h). Morphine requirements and pain scores were comparable between groups.nnnCONCLUSIONSnPropofol-alfentanil anesthesia provides good intraoperative hemodynamics and allows early extubation after coronary artery surgery.

Validation of Doppler-derived left ventricular Delta P/Delta t determination in presence of unstable acute mitral regurgitation in pigs

Validation of Doppler-derived left ventricular Delta P/Delta t determination in presence of unstable acute mitral regurgitation in pigs

Doppler-derived left ventricular rate of pressure rise (LV DP/Dt) determination in presence of severe acute mitral regurgitation in pigs

Introduction: Left ventricular (LV) rate of pressure rise (LV DP/Dt) derived from the continuous Doppler profile of mitral regurgitant jet has been proven to be a reliable [1] and reproducible [2] index of peroperative LV performance in the presence of mild to moderate mitral regurgitation (MR). This study was designed to precise the accuracy of the method in presence of severe acute MR....