Left Ventricular Function during Anaesthesia Induction and Sternotomy in Patients with Ischaemic Heart Disease A Comparison of Six Anaesthetic Techniques

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Abstract
A comparison between 5 anesthetic procedures, fentanyl (FE), morphine (MO), halothane (HAL), fentanyl/droperidol (NLA) and thiopentone (2 dose levels: PE 3 and PE 6), all supplemented with N2O, was performed with respect to the left ventricular function (LVF) during anesthesia induction and sternotomy in 47 patients with good preoperative LVF and maintained .beta.-blockers. Peroperative LVF was characterized by left ventricular stroke volume (stroke index) and external pressure volume stroke work (left ventricular stroke work index) in relation to filling pressure (pulmonary capillary wedge pressure) and outflow resistance (systemic vascular resistance). The individual patient patterns in each group indicated normal LVF in the awake state. Anesthesia induction was followed by a moderate depression of LVF in the HAL, MO, PE 3 and PE 6 groups at full dose of anesthetic agent. After addition of N2O, there was also a decrease of preload in all groups, masking any additional depressions of LVF. The response to external stimuli, endotracheal intubation and sternotomy was that of mildly depressed LVF in the majority of the patients. The hemodynamic reactions in the FE and NLA groups were more varied. In all groups some patients (.apprx. 30%) showed signs of left ventricular failing in response to external stimuli. With the exception of the more variable hemodynamic reactions in the FE and NLA groups, the differences between the anesthesia groups with respect to LVF depended mainly on extracardiac factors.