[Hemodynamic analysis of 6 different anesthesia induction procedures in coronary surgery patients]

We investigated the cardiovascular effects of intravenous thiopentone (3.0 mg/kg), etomidate (0.3 mg/kg), althesin (0.07 ml/kg), ketamine (1.5 mg/kg), diazepam (0.15 mg/kg) and flunitrazepam (0.015 mg/kg) alone and after the addition of fentanyl (0.01 mg/kg) during induction of anaesthesia in 46 premedicated patients subjected to coronary artery bypass surgery. Thiopentone, etomidate or diazepam caused only small changes in the haemodynamic determinants of myocardial oxygen supply and demand (arterial pressure, heart rate, left and right ventricular filling pressure) in patients with coronary artery disease in whom global resting left ventricular function was normal. Althesin and flunitrazepam produced a significant fall in arterial pressure, cardiac index and stroke index; heart rate increased after the administration of althesin. Ketamine markedly elevated systemic and pulmonary pressure, heart rate, systemic and pulmonary vascular resistance, right and left ventricular filling pressure. The subsequent administration of fentanyl was associated with a further decrease in arterial pressure in the althesin and flunitrazepam group. The circulatory stimulating effects of ketamine were largely abolished by fentanyl. None of the induction procedures was associated with cardiovascular stimulation during laryngoscopy and tracheal intubation.