Prevention of hypotension associated with the induction dose of remifentanil in open heart surgery for low ejection fraction patients, in Kurdistan region, Iraq

Othman Ismat Abdulmajeed

doi:10.15218/zjms.2019.035

Authors

Othman Ismat Abdulmajeed Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2019.035

Keywords:

Cardiac anesthesia, Open heart surgery, Low ejection fraction, Remifentanil, Ephedrine

Abstract

Background and objective: Hypotensive attacks commonly occur during induction of anesthesia and can result in irreversible ischemic damages to the vital body organs. This study aimed to assess the effect of using ephedrine at low doses in controlling hemodynamic changes induced by anesthesia.

Methods: A single centered single-blinded, prospective comparative study was conducted in Erbil cardiac center in periods between January 2018 and July 2018. A total of 150 patients with left ventricular ejection fraction <40% and age younger than 80 years were included in this study. They were divided into three main groups; the 1st group was the placebo group, the 2nd group received ephedrine at a dose of 0.035mg/kg body weight, and the 3rd group received ephedrine at a dose of 0.07 mg/kg body weight. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and heart rate were reported in three different phases; before induction, two minutes after induction, and five minutes after induction of anesthesia.

Results: In the placebo group, induction of anesthesia by 3mcg/Kg of remifentanil significantly reduces diastolic, systolic, and mean arterial pressure with P <0.001. At two minutes after using ephedrine at the dose of 0.035 mg/kg in the induction of anesthesia significantly increases the diastolic, systolic, and mean arterial pressure with P = 0.002, <0.001, and 0.007, respectively, and at five minutes after induction with P = 0.02, 0.03, and 0.04, respectively. Using ephedrine at a dose of 0.07mg/kg induction of anesthesia was found to significantly increase the diastolic, systolic, and mean arterial pressure with P <0.001 for all the readings. The heart rate was not significantly affected by using remifentanil alone or in combination with ephedrine during induction of anesthesia.

Conclusion: Using ephedrine at different doses during induction of anesthesia with remifentanil in patients with low ejection fraction significantly prevents hypotensive attacks.

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