Comparative Assessment of the Cardiodepressive Effect in Traditional and Modified Induction Schemes of Anesthesia in Elderly Patients with Ischemic Heart Disease

Andrii  Vitovskyi

doi:10.32345/USMYJ.4(150).2024.44-51

Andrii Vitovskyi State Institution Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-3282-6539

DOI: https://doi.org/10.32345/USMYJ.4(150).2024.44-51

Keywords: Coronary Artery Disease; Anesthesia; Propofol; Fentanyl; Ketamine; Heart.

Abstract

most anesthetic drugs have a cardiodepressant action, which in elderly patients leads to a greater inhibition of the contractile functions of cardiomyocytes. Reducing the cardiodepressant action during the induction of anesthesia in elderly patients can reduce the incidence of peri- and postoperative complications and improve the safety of anesthesia in this category of patients. The aim of the study was to improve the safety of anesthesia in elderly patients with ischemic heart disease (IHD) by determining and applying an induction scheme with minimal cardiodepressant action. We examined 40 patients over 60 (in group 1, propofol and fentanyl were used for induction; in group 2, propofol, fentanyl, ketamine). Hemodynamic parameters were recorded at the following stages: 1) upon delivery of the patient to the operating room; 2) after administration of induction drugs; 3) after intubation; 4) 25 minutes after tracheal intubation. The echocardiography data were used to calculate the stroke volume index (SVI) and cardiac index (CI). It was found that upon delivery of patients to the operating room, the values of hemodynamic parameters indicated the stability of the overall health status of patients (SVI was 31.99 ± 3.91 ml/m² for group 1 and 32.19 ± 4.29 ml/m² for group 2; СI was 2.49 ± 0.32 l/min/m² for group 1 and 2.44 ± 0.39 l/min/m²for group 2). After the administration of drugs for induction, a decrease in the indicators characterizing the contractility of the myocardium was recorded compared with the baseline: SVI was 90.7 ± 3.71% for group 1, 89.9 ± 5.86% for group 2, CI was 81.5 ± 6.6% for group 1, 85.63 ± 10.17% for group 2. There were no statistically significant differences in these indicators between the groups. After insertion of the intubation tube, a significant difference (p < 0.05) between the groups was noted in the indicators of SVI (99.91 ± 2.5% for group 1, 109.6 ± 8.16% for group 2 of the initial values) and CI (96.63 ± 11.8% for group 1, 110.38 ± 12.37% for group 2 of the initial values). In 25 minutes after intubation, statistically significant differences between the groups were observed in the parameters of SVI (87.09 ± 5.3% for group 1, 108.21 ± 8.32% for group 2; CI (79.59 ± 10.11% for group 1, 108.29 ± 9.95% for group 2). Thus, it has been demonstrated that the addition of ketamine to the combination of propofol + fentanyl prevents a decrease in myocardial contractility during induction into anesthesia in patients of the older age group.

References

Bijker, J. B., van Klei, W. A., Vergouwe, Y., Eleveld, D. J., van Wolfswinkel, L., Moons, K. G., & Kalkman, C. J. (2009). Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology, 111(6), 1217–1226. https://doi.org/10.1097/ALN.0b013e3181c14930

Fassl, J., High, K. M., Stephenson, E. R., Yarotskyy, V., & Elmslie, K. S. (2011). The intravenous anesthetic propofol inhibits human L-type calcium channels by enhancing voltage-dependent inactivation. Journal of clinical pharmacology, 51(5), 719–730. https://doi.org/10.1177/0091270010373098

Griffiths, R., Beech, F., Brown, A., Dhesi, J., Foo, I., Goodall, J., Harrop-Griffiths, W., Jameson, J., Love, N., Pappenheim, K., White, S., & Association of Anesthetists of Great Britain and Ireland (2014). Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 69 Suppl 1, 81–98. https://doi.org/10.1111/anae.12524

Jor, O., Maca, J., Koutna, J., Gemrotova, M., Vymazal, T., Litschmannova, M., Sevcik, P., Reimer, P., Mikulova, V., Trlicova, M., & Cerny, V. (2018). Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. Journal of anesthesia, 32(5), 673–680. https://doi.org/10.1007/s00540-018-2532-6

Lakatta E. G. (2003). Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation, 107(3), 490–497. https://doi.org/10.1161/01.cir.0000048894.99865.02

Reich, D. L., Hossain, S., Krol, M., Baez, B., Patel, P., Bernstein, A., & Bodian, C. A. (2005). Predictors of hypotension after induction of general anesthesia. Anesthesia and analgesia, 101(3), 622–628. https://doi.org/10.1213/01.ANE.0000175214.38450.91

Schonberger, R. B., Dai, F., Michel, G., Vaughn, M. T., Burg, M. M., Mathis, M., Kheterpal, S., Akhtar, S., Shah, N., & Bardia, A. (2022). Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65. Journal of clinical anesthesia, 80, 110846. https://doi.org/10.1016/j.jclinane.2022.110846

Südfeld, S., Brechnitz, S., Wagner, J. Y., Reese, P. C., Pinnschmidt, H. O., Reuter, D. A., & Saugel, B. (2017). Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. British journal of anaesthesia, 119(1), 57–64. https://doi.org/10.1093/bja/aex127

Trimmel, H., Helbok, R., Staudinger, T., Jaksch, W., Messerer, B., Schöchl, H., & Likar, R. (2018). S(+)-ketamine : Current trends in emergency and intensive care medicine. Wiener klinische Wochenschrift, 130(9-10), 356–366. https://doi.org/10.1007/s00508-017-1299-3

Tu, W., Yuan, H., Zhang, S., Lu, F., Yin, L., Chen, C., & Li, J. (2021). Influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition of elderly surgical patients. American journal of translational research, 13(3), 1701–1709.

van Klarenbosch, J., Stienen, G. J., de Ruijter, W., Scheffer, G. J., & de Lange, J. J. (2001). The differential effect of propofol on contractility of isolated myocardial trabeculae of rat and guinea-pig. British journal of pharmacology, 132(3), 742–748. https://doi.org/10.1038/sj.bjp.0703849

Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S. V., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T., Liu, J., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2021). Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation, 143(8), e254–e743. https://doi.org/10.1161/CIR.0000000000000950

Zhou, N., Liang, X., Gong, J., Li, H., Liu, W., Zhou, S., Xiang, W., Li, Z., Huang, Y., Mo, X., & Li, W. (2022). S-ketamine used during anesthesia induction increases the perfusion index and mean arterial pressure after induction: A randomized, double-blind, placebo-controlled trial. European journal of pharmaceutical sciences: official journal of the European Federation for Pharmaceutical Sciences, 179, 106312. https://doi.org/10.1016/j.ejps.2022.106312