Total intravenous anaesthesia with remifentanil and propofol for implantation of cardioverter defibrillators in patients with

Total intravenous anaesthesia with remifentanil and propofol for implantation of cardioverter defibrillators in patients with severely reduced left ventricular function

A. Lehmann, C. Zeitler, E. Thaler, C. Werling*, J. Boldt. Department of Anaesthesiology and Intensive Care Medicine, *Department of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Germany

Introduction

Cardio-circulatory effects of total-intravenous anaesthesia (TIVA) using remifentanil and propofol in high risk patients with severely reduced left ventricular function were determined.

Material and methods

A prospective observational study of 20 patients with severely reduced left ventricular function (ejection fraction < 30%) undergoing first-time implantation of cardioverter defibrillator (ICD) was performed at a major community teaching hospital.

TIVA was done using remifentanil and propofol. Hemodynamic data were obtained via pulmonary artery catheter at five times during the procedure: (T1) before induction of anaesthesia, (T2) after intubation, (T3) at skin incision, (T4) after first defibrillation and (T5) after extubation.

Results

Except mild decrease of arterial pressure (MAP) (T2, T3) and systemic vascular resistance (T2) no significant changes of hemodynamics occurred. Decrease of MAP could easily be treated by infusion of colloid solution. Cardiac index (CI) decreased not significantly to 1.95 l/m²/min at T3. When CI fell below 2.0 l/m²/min, infusion of dobutamine was started. 65 % of the patients needed dobutamine (mean dose:2.2 ±1.8 mg/kg/min). In all patients the infusion of dobutamine could be stopped before extubation. No patient needed sustained inotropic or ventilatory support. Patients could be extubated within 12.5 ± 4.2 min after stopping anaesthesia.

Conclusions

TIVA using remifentanil and propofol in patients with severely reduced left ventricular function is safe, well controllable and allows fast extubation after implatation of ICD. It reduces costs, as patients without complications need no longer postoperative intensive care.