Rapid-sequence induction technique in patients with severe ventricular dysfunction

The hemodynamic effects of a rapid-sequence induction and intubation technique using etomidate, fentanyl, and succinylcholine for emergency surgery in patients with severe ventricular dysfunction were studied. Ten patients undergoing orthotopic heart transplantation received fentanyl, 10 microg/kg, etomidate, 0.3 mg/kg, and succinylcholine, 1.5 mg/kg, intravenously (IV) in rapid-sequence fashion for induction. Intubation was performed 60 seconds later. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial occlusion pressure (PAo), and cardiac index (CI) were measured preinduction, postinduction, and 1 minute after intubation. Systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were calculated from the measured data. No statistically significant changes in hemodynamics occurred with induction or intubation. These results indicate that etomidate, fentanyl, and succinylcholine given in a rapid-sequence technique produce a hemodynamically stable induction with minimal response to intubation in patients with end-stage cardiac disease.