Hemodynamic action profile of propofol in comparison with midazolam. a study in coronary surgical patients
Kling, D.; Bachmann, B.; Moosdorf, R.; Hempelmann, G.
Der Anaesthesist 36(11): 640-645
1987
ISSN/ISBN: 0003-2417 PMID: 3501252 Document Number: 294210
Propofol, a rapid and short-acting i.v. anesthetic, was associated with the risk of anaphylactic reactions in its original cremophor-EL formulation. It has been reformulated in a soybean emulsion with satisfactory anesthetic properties. A former study of hemodynamic changes after i.v. induction with propofol, thiopental, methohexital, etomidate, and midazolam in patients with coronary artery disease demonstrated that in comparison to other induction agents propofol depressed systolic and diastolic arterial pressures more severely, compromising coronary perfusion. In the present investigation left ventricular parameters as well as hemodynamic effects during extracorporeal circulation (ECC) were studied in comparison to midazolam during opiate analgesia. Methods. Hemodynamic effects of 2 mg/kg body weight propofol as compared to 0.15 mg/kg midazolam were studied in 34 patients during coronary artery surgery before cannulation of the large vessels (measurement of left ventricular parameters) or during ECC (measurement of arterial perfusion pressure and oxygenator volume). Results (see Table 1, Figs. 1 and 2). Propofol decreased systolic and diastolic pressures (-27%, -22%) more than midazolam (-10%, -9%). Cardiac index and stroke volume index were diminished following both drugs (propofol: -14%, -9%; midazolam: -15%, -11%); total systemic resistance was reduced significantly by propofol (-22%). Dp/dtmax was compromised more markedly by propofol (-24%) than by midazolam (-18%), but there was no significant difference.