Comparative assessment of the vasodilatory effect in traditional and modified schemes of anesthesia induction in elderly patients with ischemic heart disease
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https://orcid.org/0000-0003-3282-6539
Abstract
The aim – to enhance the safety of anesthesia in elderly patients with ischemic heart disease (IHD) by determining an induction protocol with minimal vasodilatory effects.
Materials and methods. The study presents results from an examination of 40 patients over 60 years old with CHD who underwent off-pump coronary artery bypass grafting (CABG). The patients were divided into two groups: Group 1 (20 patients) received propofol and fentanyl, and Group 2 (20 patients) received propofol, fentanyl, and ketamine. Hemodynamic parameters were recorded at the following stages of anesthesia induction: 1. Upon arrival in the operating room; 2. After administration of induction agents; 3. Immediately after intubation; 4. 25 minutes post-intubation.
Results and discussion. Upon arrival to the operating room, hemodynamic parameters indicated the stability of the patients’ overall condition. After the administration of anesthesia agents, the mean arterial pressure (MAP) in Group 1 was 72.71±4.76 % and in Group 2 was 81.3±5.4 % of the baseline. The systemic vascular resistance index
(SVRI) was 89.9±7.02 % (Group 1) and 96.07±11.2 % (Group 2) of the baseline. Central venous pressure (CVP) decreased by 33.3±2.3 % in Group 1 and by 20.2±3.5 % in Group 2, confirming peripheral vasodilation. After intubation, the MAP values were 86.74±8.82 % (Group 1) and 92.34±7.26 % (Group 2) of the baseline, while SVRI was 89.79±11.04 % and 83.57±10.7 % of the baseline for Groups 1 and 2, respectively. CVP values at this stage were above baseline in both groups (103±4.3 % in Group 1 and 118±5.2 % in Group 2).
Conclusions. The addition of ketamine to the classical combination of propofol and fentanyl may reduce fluctuations in hemodynamic parameters during anesthesia induction, thereby enhancing the safety of elderly patients with ischemic heart disease during surgical procedures.
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References
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