Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function

Abstract

Objective: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. Design: Prospective, randomized. Setting: Major community university-affiliated hospital. Participants: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). Interventions: Anesthesia was performed using remifentanil, 0.2 to 0.3 μg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 μg.mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). Measurements and Main Results: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m2 in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 ± 1.0 mg/kg/hr) than in the MCI patients (3.0 ± 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 ± 2.4 min) versus the TCI group (15.6 ± 6.8 min). Costs were significantly lower in MCI patients ($34.73) than in TCI patients ($44.76). Conclusions: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator. Copyright © 2001 by W.B. Saunders Company