Telemetric hemodynamic assessment during anesthesia induction with propofol in experimental heart failure

Abstract

aminobutyric with reduced ventricular diastolic ventricular Millimeters Magnetic tomography; blood Standard natriuretic Abstract Background: The influence of initial propofol on cardiac hemodynamics in patients suffering from heart failure (HF) is insufficiently understood and contradicting opinions are existing. Nevertheless, propofol is often used in HF patients if etomidate is contraindicated. The development of novel telemetry sensors allows the assessment of intracardiac pressure signals in conscious animals and thus the investigation of anesthesia induction. Here, we investigated the hemodynamic effects of propofol in healthy dogs in comparison to dogs affected with HF. Methods: Telemetry sensors and pacemaker were implanted in six male beagle dogs. After wound healing, the pacemaker was programmed to 220 bpm and later to 180 bpm to induce and maintain heart failure. At baseline conditions (before pacing) and at several time points (Day 14, 28 and 42) during HF progression all animals were anesthetized with 5 mg/kg propofol i.v. Hemodynamic measurements were done to assess the effects of propofol during anesthesia induction Results: After induction with propofol, we observed a significant (p<0.001) increase in heart rate (HR) for all groups (healthy: +63 ± 53 bpm, 14d: +48 ± 23 bpm, 28d: +45 ± 20 bpm, 42d: +51 ± 28 bpm in peak) compared to individual baseline values. In addition, blood pressure (BP) increased in all HF groups (in average +17.4 ± 1.4 mmHg, p<0.05), while this effect was not present under healthy conditions. We further observed a trend towards an increase in left ventricular contractility (+dP/ dtmax) by +621.1 ± 157.0 mmHg/s (averaged peak data) in all groups. Conclusions: In dogs affected with heart failure, initial anesthesia with propofol resulted in an increase in heart rate and blood pressure, whereas no cardio depressive adverse effects could be observed on HF-relevant parameters. Therefore, propofol might be an alternative for short term anesthesia in HF patients. Nevertheless, further animal and human studies are needed to evaluate if these data can be translated into the clinical setting.