Effect of High-dose Fentanyl Versus Propofol-Fentanyl Anesthesia on Functional Recovery of Stunned Myocardium in Dogs.

Park,  Chan Jin; Yoo,  Kyung Yeon; Yoon,  Jin Seok

doi:1996.31.2.156

Korean Journal of Anesthesiology 1996;31(2):156-166.
DOI: https://doi.org/10.4097/kjae.1996.31.2.156

Chan Jin Park, Kyung Yeon Yoo, Jin Seok Yoon

¹Department of Anesthesiology, Chonnam National University Medical School, Kwangju, Korea.
²Department of Anesthesiology, St. Columban's Hospital, Korea.

Abstract

BACKGROUND
The purpose of this study was to evaluate the effects of propofol-fentanyl anesthesia in comparison with fentanyl alone on the functional recovery of postischemic reperfused myocardium and on the incidence of ischemia-reperfusion arrhythmia in an open-chest canine model.
METHODS
Dogs were subjected to 15 minutes of left anterior descending coronary artery (LAD) occlusion followed by 3 hour of reperfusion during fentanyl (n=12) or propofol plus fentanyl (n=11) anesthesia. Regional myocardial contractility was evaluated using systolic shortening (%SS), the preload recruitable stroke work slope (Mw), intramyocardial pressure (IMPs), and regional stroke work area (RSWA).
RESULTS
Dogs anesthetized with propofol-fentanyl had a significantly lower regional (%SS, Mw, IMPs, and RSWA) and global myocardial contractility (cardiac index, mean aortic pressure and left ventricular dP/dt) than fentanyl anesthetized dogs during pre-occlusion baseline. LAD occlusion produced a significant reduction in the regional contractile functions (%SS, Mw, IMPs, and RSWA) in both groups. During reperfusion, gradual return of the regional contractile functions (%SS, Mw, IMPs, RSWA) toward their respective baselines were observed without any differences between the groups. However, ventricular fibrillation associated with LAD occlusion was lower in the propofol-fentanyl group than in the fentanyl group (zero vs 33%, p<0.05).
CONCLUSIONS
Propofol supplementation over moderate-dose fentanyl reduces reperfusion arrhythmia during coronary occlusion and subsequent reperfusion but does not improve functional recovery of post-ischemic, reperfused myocardium compared with high-dose fentanyl anesthesia in dogs.

Key Words: Heart myocardial ischemia; arrhythmia; myocardial contractility; Anesthetic; Intravenous fentanyl; propofol