Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function
Objective: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twe...
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| Veröffentlicht in: | Journal of cardiothoracic and vascular anesthesia 2001-08, Vol.15 (4), p.445-450 |
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| creator | Lehmann, Andreas Boldt, Joachim Römpert, Reni Thaler, Elfi Kumle, Bernhard Weisse, Udo |
| description | Objective: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction 2 L/min/m2 in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 ± 1.0 mg/kg/hr) than in the MCI patients (3.0 ± 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 ± 2.4 min) versus the TCI group (15.6 ± 6.8 min). Costs were significantly lower in MCI patients ($34.73) than in TCI patients ($44.76). Conclusions: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator. Copyright © 2001 by W.B. Saunders Company |
| doi_str_mv | 10.1053/jcan.2001.24979 |
| format | Article |
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Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). Interventions: Anesthesia was performed using remifentanil, 0.2 to 0.3 μg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 μg.mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). Measurements and Main Results: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m2 in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 ± 1.0 mg/kg/hr) than in the MCI patients (3.0 ± 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 ± 2.4 min) versus the TCI group (15.6 ± 6.8 min). Costs were significantly lower in MCI patients ($34.73) than in TCI patients ($44.76). Conclusions: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator. Copyright © 2001 by W.B. Saunders Company</description><identifier>ISSN: 1053-0770</identifier><identifier>EISSN: 1532-8422</identifier><identifier>DOI: 10.1053/jcan.2001.24979</identifier><identifier>PMID: 11505347</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Anesthesia, Intravenous - economics ; Anesthetics, Intravenous - administration & dosage ; Anesthetics, Intravenous - economics ; Biological and medical sciences ; Defibrillators, Implantable ; Female ; Hemodynamics ; Humans ; Infusions, Intravenous - economics ; Infusions, Intravenous - methods ; Male ; Medical sciences ; Middle Aged ; Piperidines - economics ; propofol ; Propofol - administration & dosage ; Propofol - economics ; Prospective Studies ; reduced left ventricular function ; remifentanil ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; target-controlled infusion ; Ventricular Dysfunction, Left - physiopathology</subject><ispartof>Journal of cardiothoracic and vascular anesthesia, 2001-08, Vol.15 (4), p.445-450</ispartof><rights>2001 W.B. Saunders Company</rights><rights>2001 INIST-CNRS</rights><rights>Copyright 2001 by W.B. Saunders Company.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-e5c6546313961994254b3888bb152f83ebd79d5502a0da7ebfb717035b9412ea3</citedby><cites>FETCH-LOGICAL-c372t-e5c6546313961994254b3888bb152f83ebd79d5502a0da7ebfb717035b9412ea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/jcan.2001.24979$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1123621$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11505347$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lehmann, Andreas</creatorcontrib><creatorcontrib>Boldt, Joachim</creatorcontrib><creatorcontrib>Römpert, Reni</creatorcontrib><creatorcontrib>Thaler, Elfi</creatorcontrib><creatorcontrib>Kumle, Bernhard</creatorcontrib><creatorcontrib>Weisse, Udo</creatorcontrib><title>Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function</title><title>Journal of cardiothoracic and vascular anesthesia</title><addtitle>J Cardiothorac Vasc Anesth</addtitle><description>Objective: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). Interventions: Anesthesia was performed using remifentanil, 0.2 to 0.3 μg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 μg.mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). Measurements and Main Results: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m2 in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 ± 1.0 mg/kg/hr) than in the MCI patients (3.0 ± 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 ± 2.4 min) versus the TCI group (15.6 ± 6.8 min). Costs were significantly lower in MCI patients ($34.73) than in TCI patients ($44.76). Conclusions: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator. Copyright © 2001 by W.B. Saunders Company</description><subject>Anesthesia, Intravenous - economics</subject><subject>Anesthetics, Intravenous - administration & dosage</subject><subject>Anesthetics, Intravenous - economics</subject><subject>Biological and medical sciences</subject><subject>Defibrillators, Implantable</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Infusions, Intravenous - economics</subject><subject>Infusions, Intravenous - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Piperidines - economics</subject><subject>propofol</subject><subject>Propofol - administration & dosage</subject><subject>Propofol - economics</subject><subject>Prospective Studies</subject><subject>reduced left ventricular function</subject><subject>remifentanil</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>target-controlled infusion</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><issn>1053-0770</issn><issn>1532-8422</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kT9vFDEQxS1EREKgpkMuEN1e_Ge9XpcoAoIUKU1SW17vOOfgsw_be1G-Ax8aX-4kKEg1o5nfPI3eQ-gDJStKBL94sCauGCF0xXol1St0RgVn3dgz9rr1DemIlOQUvS3loWFUCPkGnbbaVr08Q79vTb6H2tkUa04hwIx9dEvxKeKU8cbExYTwhP-7d3ib0za5FNoQr_39usu-_MRbUz3EWvCjr2tcYAcZmkaGebFNIICreNeA7O0STMZuibY2xXfoxJlQ4P2xnqO7b19vL6-665vvPy6_XHeWS1Y7EHYQ_cApVwNVqmein_g4jtNEBXMjh2mWahaCMENmI2Fyk6SScDGpnjIw_Bx9Pui2938tUKre-GIhBBMhLUVLSpTgw9DAiwNocyolg9Pb7DcmP2lK9N5dvQ9A7wPQzwG0i49H6WXawPyXPzregE9HwBRrgssmWl_-4RgfGG2YOmDQfNh5yLrY5mmzz2ewVc_Jv_jDHxgGpPc</recordid><startdate>20010801</startdate><enddate>20010801</enddate><creator>Lehmann, Andreas</creator><creator>Boldt, Joachim</creator><creator>Römpert, Reni</creator><creator>Thaler, Elfi</creator><creator>Kumle, Bernhard</creator><creator>Weisse, Udo</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20010801</creationdate><title>Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function</title><author>Lehmann, Andreas ; Boldt, Joachim ; Römpert, Reni ; Thaler, Elfi ; Kumle, Bernhard ; Weisse, Udo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-e5c6546313961994254b3888bb152f83ebd79d5502a0da7ebfb717035b9412ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Anesthesia, Intravenous - economics</topic><topic>Anesthetics, Intravenous - administration & dosage</topic><topic>Anesthetics, Intravenous - economics</topic><topic>Biological and medical sciences</topic><topic>Defibrillators, Implantable</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Infusions, Intravenous - economics</topic><topic>Infusions, Intravenous - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Piperidines - economics</topic><topic>propofol</topic><topic>Propofol - administration & dosage</topic><topic>Propofol - economics</topic><topic>Prospective Studies</topic><topic>reduced left ventricular function</topic><topic>remifentanil</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>target-controlled infusion</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lehmann, Andreas</creatorcontrib><creatorcontrib>Boldt, Joachim</creatorcontrib><creatorcontrib>Römpert, Reni</creatorcontrib><creatorcontrib>Thaler, Elfi</creatorcontrib><creatorcontrib>Kumle, Bernhard</creatorcontrib><creatorcontrib>Weisse, Udo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lehmann, Andreas</au><au>Boldt, Joachim</au><au>Römpert, Reni</au><au>Thaler, Elfi</au><au>Kumle, Bernhard</au><au>Weisse, Udo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function</atitle><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle><addtitle>J Cardiothorac Vasc Anesth</addtitle><date>2001-08-01</date><risdate>2001</risdate><volume>15</volume><issue>4</issue><spage>445</spage><epage>450</epage><pages>445-450</pages><issn>1053-0770</issn><eissn>1532-8422</eissn><abstract>Objective: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). Interventions: Anesthesia was performed using remifentanil, 0.2 to 0.3 μg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 μg.mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). Measurements and Main Results: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m2 in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 ± 1.0 mg/kg/hr) than in the MCI patients (3.0 ± 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 ± 2.4 min) versus the TCI group (15.6 ± 6.8 min). Costs were significantly lower in MCI patients ($34.73) than in TCI patients ($44.76). Conclusions: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator. Copyright © 2001 by W.B. Saunders Company</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>11505347</pmid><doi>10.1053/jcan.2001.24979</doi><tpages>6</tpages></addata></record> |
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| subjects | Anesthesia, Intravenous - economics Anesthetics, Intravenous - administration & dosage Anesthetics, Intravenous - economics Biological and medical sciences Defibrillators, Implantable Female Hemodynamics Humans Infusions, Intravenous - economics Infusions, Intravenous - methods Male Medical sciences Middle Aged Piperidines - economics propofol Propofol - administration & dosage Propofol - economics Prospective Studies reduced left ventricular function remifentanil Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart target-controlled infusion Ventricular Dysfunction, Left - physiopathology |
| title | Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function |
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