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Rapid-sequence induction technique in patients with severe ventricular dysfunction.

P M Waterman1, R Bjerke

  • 1Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, PA 15213-2582, USA.

Journal of Cardiothoracic Anesthesia
|October 1, 1988
PubMed
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Rapid-sequence induction using etomidate, fentanyl, and succinylcholine provides stable hemodynamics for emergency surgery in patients with severe ventricular dysfunction. This technique minimizes hemodynamic responses during induction and intubation in critically ill cardiac patients.

Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Patients with severe ventricular dysfunction present unique anesthetic challenges.
  • Rapid-sequence induction and intubation (RSI) is critical in emergency surgery.
  • Hemodynamic stability is paramount in patients with end-stage cardiac disease.

Purpose of the Study:

  • To evaluate the hemodynamic effects of a specific RSI technique.
  • To assess the safety of etomidate, fentanyl, and succinylcholine in this patient population.
  • To determine the impact of RSI on key hemodynamic parameters.

Main Methods:

  • A prospective study involving ten patients undergoing orthotopic heart transplantation.
  • Administration of fentanyl (10 microg/kg), etomidate (0.3 mg/kg), and succinylcholine (1.5 mg/kg) intravenously for RSI.

Related Experiment Videos

  • Continuous monitoring of heart rate, mean arterial pressure, central venous pressure, pulmonary artery pressures, and cardiac index preinduction, postinduction, and postintubation.

    • Main Results:

    • No statistically significant changes were observed in heart rate, mean arterial pressure, or cardiac index.
    • Central venous pressure, mean pulmonary arterial pressure, and pulmonary arterial occlusion pressure remained stable.
    • Calculated systemic and pulmonary vascular resistance indices showed no significant alterations.

    Conclusions:

    • The combination of etomidate, fentanyl, and succinylcholine for RSI is hemodynamically stable in patients with severe ventricular dysfunction.
    • This anesthetic technique offers a safe induction and intubation strategy for emergency surgery in patients with end-stage cardiac disease.
    • Minimal hemodynamic response to induction and intubation suggests suitability for high-risk cardiac surgical patients.