Intravenous anesthesia for the patient with left ventricular dysfunction.

@article{citeulike:2463085, abstract = {Patients with heart failure have a diminished cardiac reserve capacity that may be further compromised by anesthesia. In addition to depression of sympathetic activity, most anaesthetics interfere with cardiovascular performance, either by a direct myocardial depression or by modifying cardiovascular control mechanisms. Etomidate causes the least cardiovascular depression. It is popular for induction of anesthesia in cardiac-compromised patients; however, it is not suitable for maintenance of anesthesia because it depresses adrenocortical function. Ketamine has a favorable cardiovascular profile related to central sympathetic stimulation and inhibition of neuronal catecholamine uptake. These counteract its direct negative inotropic effect. In patients with a failing myocardium, however, the negative inotropic effects may be unmasked, resulting in deterioration in cardiac performance and cardiovascular instability. Propofol is the most popular intravenous anesthetic for maintenance of anesthesia. It does have a negative inotropic effect, but the net effect on myocardial contractility is insignificant at clinical concentrations, probably because of a simultaneous increase in the sensitivity of the myofilaments to Ca2+. Propofol protects the myocardium against ischemia-reperfusion injury, an action derived from its antioxidant and free-radical-scavenging properties as well as the related inhibition of the mitochondrial permeability transition pore. For intravenous anesthesia, propofol is always combined with an opioid. Opioids have relatively few cardiovascular side effects and, in particular, do not cause myocardial depression. Indeed, they are cardioprotective, with antiarrhythmic activity, and induce pharmacologic preconditioning of the myocardium by a mechanism similar to the inhalational anesthetics.}, address = {Department of Anaessthesiology, Leiden University Medical Centre, The Netherlands. j.g.bovill@lumc.nl}, author = {Bovill, J. G. }, citeulike-article-id = {2463085}, issn = {1089-2532}, journal = {Semin Cardiothorac Vasc Anesth}, keywords = {anesthesia, chf, icu, picu, sedation}, month = {March}, number = {1}, pages = {43--48}, posted-at = {2008-09-09 17:41:26}, priority = {2}, title = {Intravenous anesthesia for the patient with left ventricular dysfunction.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/16703233}, volume = {10}, year = {2006} }

TY - JOUR ID - citeulike:2463085 L3 - citeulike-article-id:2463085 N2 - Patients with heart failure have a diminished cardiac reserve capacity that may be further compromised by anesthesia. In addition to depression of sympathetic activity, most anaesthetics interfere with cardiovascular performance, either by a direct myocardial depression or by modifying cardiovascular control mechanisms. Etomidate causes the least cardiovascular depression. It is popular for induction of anesthesia in cardiac-compromised patients; however, it is not suitable for maintenance of anesthesia because it depresses adrenocortical function. Ketamine has a favorable cardiovascular profile related to central sympathetic stimulation and inhibition of neuronal catecholamine uptake. These counteract its direct negative inotropic effect. In patients with a failing myocardium, however, the negative inotropic effects may be unmasked, resulting in deterioration in cardiac performance and cardiovascular instability. Propofol is the most popular intravenous anesthetic for maintenance of anesthesia. It does have a negative inotropic effect, but the net effect on myocardial contractility is insignificant at clinical concentrations, probably because of a simultaneous increase in the sensitivity of the myofilaments to Ca2+. Propofol protects the myocardium against ischemia-reperfusion injury, an action derived from its antioxidant and free-radical-scavenging properties as well as the related inhibition of the mitochondrial permeability transition pore. For intravenous anesthesia, propofol is always combined with an opioid. Opioids have relatively few cardiovascular side effects and, in particular, do not cause myocardial depression. Indeed, they are cardioprotective, with antiarrhythmic activity, and induce pharmacologic preconditioning of the myocardium by a mechanism similar to the inhalational anesthetics. IS - 1 JF - Semin Cardiothorac Vasc Anesth SN - 1089-2532 AD - Department of Anaessthesiology, Leiden University Medical Centre, The Netherlands. j.g.bovill@lumc.nl EP - 48 TI - Intravenous anesthesia for the patient with left ventricular dysfunction. VL - 10 SP - 43 KW - anesthesia KW - chf KW - icu KW - picu KW - sedation AU - Bovill, JG PY - 2006/03// UR - http://view.ncbi.nlm.nih.gov/pubmed/16703233 ER -