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CRITICAL CARE AND TRAUMA

Dynamic Cardiocirculatory Control During Propofol Anesthesia in Mechanically Ventilated Patients

Cornelius Keyl, MD^*, Annette Schneider, MD^*, Martin Dambacher, MD, Ulrike Wegenhorst, MD^*, Matthias Ingenlath, MD^*, Michael Gruber, PhD^*, and Luciano Bernardi, MD

*Department of Anesthesiology, University Medical Center, University of Regensburg, Germany; Department of Internal Medicine, University of Pavia and Istituto di Ricovero e Cura a Carattere Scientifico S. Matteo, Pavia, Italy; and Fraunhofer IPM, Freiburg, Germany

Address correspondence and reprint requests to Cornelius Keyl, MD, Department of Anesthesiology, University Medical Center, 93042 Regensburg, Germany. Address e-mail to Keyl{at}rkananw1.ngate.uni-regensburg.de

We evaluated dynamic cardiovascular control by spectral analytical methods in 20 young adults anesthetized with propofol (2.5 mg/kg, followed by continuous infusion of 0.1 mg/kg/min) and in an awake control group during cyclic stimulation of the carotid baroreceptors via sinusoidal neck suction at 0.2 Hz (baroreflex response mediated mainly by vagal activity) and at 0.1 Hz (baroreflex response mediated by vagal and sympathetic activity). During anesthesia and mechanical ventilation at 0.25 Hz, major underdampened hemodynamic oscillations occurred at 0.055 ± 0.012 Hz. The response of RR intervals to baroreceptor stimulation at 0.2 Hz was markedly decreased during anesthesia (median of transfer function magnitude between neck suction and RR intervals 3% of the awake control). Blood pressure response to baroreceptor stimulation at 0.1 Hz was significantly decreased during anesthesia to 26% (systolic blood pressure), and 44% (diastolic blood pressure) of the awake control. There was a significant delay in baroreflex effector responses during anesthesia. Our results demonstrate a markedly depressed vagally mediated heart rate response and an impaired blood pressure response to cyclic baroreceptor stimulation during propofol anesthesia in mechanically ventilated patients. The disturbed baroreflex control is accompanied by an irregular dynamic behavior of cardiovascular regulation, indicating a decreased stability of the control system.

Implications: An irregular dynamic behavior of the cardiovascular control system, associated with an impaired baroreflex control of heart rate and blood pressure, can be observed during propofol anesthesia in mechanically ventilated subjects.

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