Why the study?
Does inhalational induction with sevoflurane improve left ventricular mechanical performance compared to intravenous induction with fentanyl and propofol in elderly patients?
Does inhalational induction with sevoflurane improve left ventricular mechanical performance compared to intravenous induction with fentanyl and propofol in elderly patients?
Sevoflurane may be preferable to fentanyl and propofol for induction of anaesthesia in elderly patients due to a lesser reduction in left ventricular mechanical performance.
Sevoflurane induction associated with smaller post-induction drop in ventricular-arterial coupling than fentanyl/propofol; hypothesis-generating in elderly patients, requires RCT confirmation before practice change.
We investigated changes in left ventricular mechanical performance in 40 patients aged > 70 years in whom anaesthesia had been induced with sevoflurane or with fentanyl and propofol. The ratio of ventricular contractility to arterial properties, which reflects left ventricular performance, was estimated from the ratio of ventricular end-systolic elastance to effective arterial elastance. This ratio decreased after induction in both groups, the magnitude of the decrease being significantly greater in the fentanyl/propofol group than in the sevoflurane group. Decreases in mean arterial pressure after induction of anaesthesia in the two groups were similar, whereas the magnitude of the decrease in heart rate in the sevoflurane group was greater than that in the fentanyl/propofol group. Sevoflurane may therefore be preferable to fentanyl and propofol for induction of anaesthesia in elderly patients because of its lesser effect on left ventricular performance.
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Nishikawa et al. (2004) studied this question.
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