[Effects of propofol induction on haemodynamics]. / Wplyw indukcji dozylnej propofolem na funkcje ukladu krazenia.

BACKGROUND: Propofol is probably the most popular intravenous anaesthetic in daily practice. Its use is known to be associated with dose-dependent cardiovascular compromise. We have assessed the effect of a single dose of propofol on cardiovascular function. METHODS: Eighty-six ASA I and II patients of both sexes, scheduled for elective thoracic cancer surgery, were enrolled to the study. Midazolam 7.5 mg was given as premedication. All patients received epidural or paravertebral catheters one day before the surgery, and a Swan-Ganz catheter before induction. MAP, CO, SVI, PAP, PCWP, SVRI, PVRI, LVSWI, RWSWI and CPP were measured before induction (I) and after administration of 1 mg kg(-1) propofol with 1-3 microg kg(-1) fentanyl, during spontaneous respiration (II). RESULTS: Propofol increased: heart rate (8%), PAP (12%), PVRI (27%), PCWP (27%) and decreased MAP (4.5%), CI (12%), SVI (18%), LVSWI (23%), RVSWI (17%). CPP decreased by 7%. SVRI remained unchanged. DISCUSSION AND CONCLUSIONS: The results indicated that 1 mg kg(-1) propofol moderately compromised cardiac contractility and increased afterload on the right ventricle, without significant effect on coronary perfusion pressure. The cardiovascular compromise was clinically insignificant, but caution is required when propofol is administered in larger doses.

[Continuous epidural anaesthesia vs paravertebral block for lung surgery--a comparative study]. / Porównanie skutecznosci ciaglego znieczulenia zewnatrzoponowego i przykregowego podczas operacji plucnych.

BACKGROUND: This prospective randomized study compared the effects of two techniques--thoracic epidural analgesia (TEA), and thoracic paravertebral analgesia (TPVA), on pain control and haemodynamics after thoracotomy. METHODS: Sixty adult ASA 1 and 2 patients were randomly assigned to two equal groups to receive either: (I) 10 mL of 0.5% bupivacaine before and at the end of surgery via a thoracic epidural catheter; or (II) 30 mL of 0.5% bupivacaine before, and 15 mL at the end of surgery, via a thoracic paravertebral catheter. During the postoperative period, patients of both groups received continuous infusion of 0.1 mL kg(-1) h(-1) into the respective spaces. This technique was supplemented by patient-controlled intravenous infusion of fentanyl (bolus 0.02 mg; lock-out time 12 min). RESULTS: The average dose of fentanyl administered intraoperatively in both groups was similar. Blood pressure and heart rate were significantly lower in the TEA group. Pain intensity, assessed using the NRS and PHHPS scales, was similar in both groups. PCA fentanyl consumption was higher in theTPVA group. CONCLUSIONS: (1) Thoracic paravertebral anaesthesia can be regarded as a satisfactory alternative to epidural anaesthesia for control of post-thoracotomy pain. (2) The effect of paravertebral anaesthesia on blood pressure and heart rate is minimal, therefore this technique may be recommended for patients with coexisting circulatory disease. (3) The frequency of use of the PCA system cannot be regarded as an objective method of pain assessment.