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Anesth Analg 1983; 62:865-869
© 1983 International Anesthesia Research Society
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Preoperative Prophylactic Digitalization of Patients with Coronary Artery Disease-A Randomized Echocardiographic and Hemodynamic Study

Michel L. J. Pinaud, MD, Yvonnick A. G. Blanloeil, MD, and Rémy J. Souron, MD

Received from the Département d'Anesthésiologie Centre Hospitalier Universitaire, 44035 Nantes Cedex, France.

Abstract

Echocardiographic and hemodynamic changes that suggest impaired cardiac pump function due to recovery from anesthesia in patients with coronary artery disease (CAD) without preoperative heart failure led us to investigate the effects of preoperative intravenous digoxin (D) on left ventricular (LV) function of such patients before and after abdominal surgery. Sixteen patients without previous myocardial infarction were divided into a control group (n = 8) receiving no D and a digitalized group (n = 8) receiving intravenous D(10 (µg·kg–1)48hr preoperatively with maintenance doses 24 and 3 hr before surgery. Plasma digoxin levels were measured by radioimmunoassays (RIA) 3 hr after each intravenous dose. M-mode echocardiograms (E) were obtained and systemic hemodynamics measured before anesthesia and 30 and 120 min (hereafter, 30 and 120) after termination of anesthesia. Holter monitoring recorded ECG changes for 12 hr before surgery as well as during the operative and postoperative periods. There were no differences in preoperative hemodynamic and echocardiographic findings in the two groups of patients. Postoperatively, in the control group at 30 and 120 there were statistically significant increases in LV internal dimensions, heart rate, mean arterial pressure (MAP), pulmonary capillary wedge pressure, and systemic vascular resistance, and significant decreases in shortening fraction, cardiac index (CI), and stroke index. In digitalized patients no changes occurred except for an increase in MAP at 30 and increase in CI at 120. No arrhythmias were detected in the digitalized patients. This study confirms that recovery from anesthesia is associated with cardiac pump failure in patients with CAD without previous heart failure. Preoperative intravenous digoxin prevents this impairment in cardiac function without adverse effects, including arrhythmias.

Key Words: HEART, Coronary artery disease: digitalis, prophylactic






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.