Summary
The effects of induction of anaesthesia by ketamine 2 mg- kg-1 were studied in six patients with valvular heart disease before tracheal intubation and operation. Cardiac index was unaffected because a mean decrease in stroke index was compensated for by a mean increase in heart rate. A significant increase was found in mean arterial pressure, pulmonary arterial mean pressure, pulmonary capillary wedge pressure and central venous pressure. Systemic vascular resistance increased, but not significantly, whereas pulmonary vascular resistance increased significantly by more than 150 per cent. Right ventricular minute work index increased in all patients, and the increase was as much as 400 per cent. Left ventricular minute work index increased in four of the six patients, but the magnitude of the increase was not so marked. It is therefore concluded that ketamine causes pronounced pulmonary vasoconstriction and an undesirable strain on the myocardium. Such effects could prove deleterious in patients with limited functional reserve of the right ventricle.
Résumé
On a étudié les effets de la kétamine à la dose de 2 mg-kg-1 comme agent ďinduction de ľanesthésie chez six patients porteurs de cardiopathies valvulaires. Les observations ont été effectuées aprçs ľinduction, avant ľintubation et la chirurgie. Ľindex cardiaque est demeuré inchangé, la diminution moyenne de ľindex ďéjection étant compensée par une augmentation de la fréquence cardiaque. On a observé une élévation significative de la pression artérielle moyenne, de la pression capillaire pulmonaire moyenne, de la pression veineuse centrale et de la pression capillaire bloquée. La résistance vasculare systémique s’est élevée de façon non significative, alors que la résistance vasculaire pulmonaire s’élevait de façon significative (plus de 150pourcent). Ľindex de travail ventriculaire droit-minute s’est élevé chez tous les sujets; on a même observé des élévations de ľordre de 400 pour cent. Ľindex de travail ventriculaire gauche minute s’est élevé chez quatre des six patients, mais les élévations n’étaient pas si importantes que celles observées au niveau du ventricule droit. Les auteurs concluent que la Kétamine taxe le myocarde de façon indésirable et produit une vasoconstriction pulmonaire prononcée. Ces effets pourraient s’avérer nocifs chez des malades à réserve myocardique limitée.
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Spotoft, H., Korshin, J.D., Søjrensen, M.B. et al. The cardiovascular effects of ketamine used for induction of anaesthesia in patients with valvular heart disease. Canad. Anaesth. Soc. J. 26, 463–467 (1979). https://doi.org/10.1007/BF03006157
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DOI: https://doi.org/10.1007/BF03006157