Left Ventricular Systolic and Diastolic Function Is Unaltered During Propofol Infusion in Newborn Swine

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Abstract

Propofol is a cardiac depressant with minimal diastolic effects in the adult myocardium.Cardiac effects of propofol in the newborn are unknown. We examined hemodynamic variables and systolic and diastolic left ventricular function in 12 newborn pigs exposed to propofol at three different infusion rates (7.5, 15, and 30 mg [center dot] kg-1 [center dot] h-1) in random order with a background of fentanyl (100 [micro sign]g [center dot] kg-1 [center dot] h-1). Left ventricular (LV) pressure (Plv) and LV anterior-posterior dimension, determined by sonomicrometry, were continuously monitored. Mean arterial pressure (MAP), heart rate (HR), and LV end-diastolic pressure (LVEDP) were determined at every infusion. Systolic function was assessed by the maximal pressure-time derivative (dP/dtmax), the slope of the end-systolic pressure-dimension relationship (ESP-D), and by the preload recruitable stroke work index (PRSWI). Diastolic function was assessed by relaxation indices, the minimal pressure-time derivative (dP/dtmin) and the relaxation time constant (tau), and by a stiffness index, the slope of the EDP-D relationship. MAP decreased approximately 25%, from 75.9 +/- 15.6 to 56.3 +/- 14.8 mm Hg (P < 0.05) with propofol, with no dose effect. HR and LVEDP were unchanged from control. Both dP/dtmax and dP/dtmin decreased with propofol infusion, but load-independent indices of systolic function (ESP-D slope and PRSWI) and tau were unchanged. Diastolic stiffness was not affected with either 7.5- or 30-mg [center dot] kg-1 [center dot] h (-1) infusions but decreased significantly from 0.27 +/- 0.18 mm Hg/mm at control to 0.18 +/- 0.18 mm Hg/mm (P < 0.05) with propofol 15 mg [center dot] kg-1 [center dot] h-1. With this profile, propofol may be useful for the newborn requiring anesthesia. Implications: Most anesthetics depress heart function in the newborn. We examined both heart contraction and relaxation during anesthesia with propofol in newborn pigs. Propofol had minimal influence on heart function in this model at the doses studied. This may therefore be a useful anesthetic to test in the newborn human.

(Anesth Analg 1998;86:717-23)

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