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

References

Woerlee GM. Anesthesia and hypotension 2005-2018. (Accessed March 12, 2019, at http://www.anesthesiaweb.org/hypotension.php).

Epstein RH, Dexter F, Schwenk ES. Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists’ performance. Br J Anaes 2017; 119(1):106–14.

Morris RW, Watterson LM, Westhorpe RN, Webb RK. Crisis management during anaesthesia: hypotension. Qual Saf Health Care 2005; 14(3):e11.

Bryant H, Bromhead H. Intraoperative hypotension anaesthesia tutorial of the week 148. 24th August 2009. (Accessed March 12, 2019, at http://www.frca.co.uk/Documents/148%20Intraoperative%20hypotension.pdf).

Barak M, Yoav L, Abu El-Naaj I. Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: A review of the literature. TSWJ 2015; 2015:480728.

Alwardt CM, Redford D, Larson DF. General anesthesia in cardiac surgery: a review of drugs and practices. J Extra Corpor Technol 2005; 37(2):227–35.

Yang Y, Guo Q, Fu D, Wu H, Dai R. Induction of remifentanil by bradycardia and hypotension through distinct biochemical mechanisms. Afr J Pharm Pharmaco 2012; 6(38):2729–34.

Elliot P, O’Hare R, Bill KM, Phillips AS, Gibson FM, Mirakhur RK. Severe cardiovascular depression with remifentanil. Anesth Analg 2000; 91:58–61.

Kazmaier S, Hanekop GG, Buhre W, Weyland A, Busch T, Radke OC, et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br J Anaesth 2000; 84:578–83.

Reid JE, Mirakhur RK. Bradycardia after administration of remifentanil. Br J Anaesth 2000; 84:422–3.

Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS. Drugs 2004; 18:1085–104.

Habib AS, Parker JL, Maguire AM, Rowbotham DJ, Thompson JP. Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly. Br J Anaesth 2002; 88(3):430–3.

Boztas N, Oztekin S, Ozkardes S, Akan M, Ozbilgin S, Baytok A. Effects of different doses of remifentanil on hemodynamic response to anesthesia induction in healthy elderly patients, Curr Med Res Opin2017; 33(1):85–90.

Masjedi M, Zand F, Kazemi AP, Hoseinipour A. Prophylactic effect of ephedrine to reduce hemodynamic changes associated with anesthesia induction with propofol and remifentanil. J Anaesthesiol Clin Pharmacol 2014; 30:217–21.

Macarthur A. Solving the problem of spinal- induced hypotension in obstetric anesthesia. Can J Anaesth 2002; 49:536–9.

Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology 2009; 111:753–65.

Bhattarai B, Bhat SY, Upadya M. Comparison of bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial pressure during spinal anesthesia in cesarean section. J Nepal Med Assoc 2010; 49:23–8.

El-Tahan MR. Preoperative ephedrine counters hypotension with propofol anesthesia during valve surgery: A dose dependent study. Ann Card Anaesth 2011; 14:30–40.

Kol IO, Kaygusuz K, Gursoy S, Cetin A, Kahramanoglu Z, Ozkan F, et al. The effects of intravenous ephedrine during spinal anesthesia for cesarean delivery: A Randomized Controlled Trial. J Korean Med Sci 2009; 24(5):883–8.

Published
2019-08-06
How to Cite
Abdulmajeed, O. (2019). Prevention of hypotension associated with the induction dose of remifentanil in open heart surgery for low ejection fraction patients, in Kurdistan region, Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 23(2), 283-289. https://doi.org/10.15218/zjms.2019.035
Section
Original Articles