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In 36 patients with acquired heart disease effects of 0.15 mg/kg piritramide on hemodynamics, inotropic state and myocardial oxygen consumption were investigated during and after cardiac surgery (basic neuroleptanalgesia). It could be demonstrated, that piritramide is not inducing any negative inotropic effects compared to a control group (n = 36) and a fentanyl group (0.003 mg/kg, n = 31). There were only small changes in HR, SV, PRA and PLA. A slight decrease in Part, PLV, and arterial perfusion pressure during extracorporeal circulation is interpreted as a peripheral vasodilatation. The resulting decrease in heart work caused a significant decrease in myocardial oxygen consumption (-18%), which is of special advantage in patients with coronary heart disease.

In 93 cardiac patients the effects of low, mean and high fentanyl dosage--0.003 mg/kg, 0.015 mg/kg and 0.03 mg/kg--on haemodynamics, inotropic state and myocardial oxygen consumption were investigated during surgical procedures under basic neuroleptanalgesia. There was an increase in heart rate with the low fentanyl dosage, whereas mean and high doses lowered heart rate. Decreases in arterial pressure, left ventricular pressure, and perfusion pressure during extracorporal circulation as well are interpreted as peripheral vasodilatory effects. Most of the measured and calculated hemodynamic parameters such as PAP, dp/dtmax, CI, TSR decreased. There was, however, no decrease in myocardial contractility, when considering changes in heart rate, pre- and after-load and dp/dtmax. The decrease in heart work and myocardial oxygen consumption may be of advantage especially in patients with coronary heart disease.

We reported on the haemodynamic effects of 0.03 mg/kg flunitrazepam during surgical procedures in neuroleptanalgesia in 39 patients with congenital or acquired heart diseases, functional class II-IV. The benzodiazepine derivative did not cause any relevant effect on the inotropic state of the myocardium. There were only minor changes in cardiac index, stroke index, right and left atrial pressure. Changes in arterial pressure and left ventricular pressure during and immediately after surgical procedures, and in arterial perfusion pressure during extracorporeal circulation, as well as an only short lasting increase in heart rate were demonstrative a peripheral vasodilator effect. The decrease in ventricular work and myocardial oxygen consumption are of value in patients with coronary heart disease, especially immediately after surgical procedures. Flunitrazepam is considered an additional drug during neuroleptanalgesia, when hypertension is causing some problems.

In previous study it was demonstrated that the clinical use of bupivacaine 0.75% for peridural anesthesia appears to be without risk. There was seen no toxicity (bradycardia, convulsion, respiratory depression etc) at the measured plasma levels. Very important is the early onset of action of this drug contrary to the other used concentrations. It is useful for a major surgery. Hypotension can be avoided by applying volume transfusion.

Changes in hemodynamics, inotropic state, and myocardial oxygen consumptom were investigated in a total of 70 patients with coronary disease after intravenous application of nitroglycerin (0.4 mg., 0.2 mg., and 2 mg. per hour). The results demonstrate that nitroglycerin enlarges therapeutic possibilities during and immediately after operations in patients with limited coronary reserve. The decrease in myocardial oxygen consumption, dependent on dose, ranged between 15.8 and 22.9 per cent.

The haemodynamic effects of the new selective beta 1-receptor-agonist prenalterol were investigated in two groups each of 8 patients. Dosages of 500 microgram/5 min and 100 microgram/1 min were given after direct closure of atrial septal defect under neuroleptanalgesia. Prenalterol 500 microgram/5 min increased cardiac index (37.5%), heart rate (19%), stroke index (16.2%), mean arterial pressure (26.5%) and dp/dtmax (84.5%) significantly. Total systemic resistance, total pulmonary vascular resistance and mean pulmonary pressure remained constant. Filling pressures of both ventricles decreased slightly but significantly. Maximal hemodynamic changes after infusion of 100 microgram/1 min prenalterol were half as great as with 500 microgram/5 min and occurred 3 min earlier. The haemodynamic action of prenalterol was rather long lasting. One hour after cessation of the drug-infusion there were still detectable haemodynamic effects. In contrast to investigations in awake patients there was a greater increase in heart rate, which is referred to influences on the vagal reflex caused by anaesthesia.

In 52 patients with acquired heart disease haemodynamic effects of 0,2 mg/kg and 1,0 mg/kg morphine were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: heart rate (HR), arterial pressure (Part, Psyst, Pdiast), pulmonary artery pressure (PAP), right (PRA) and left atrial pressure (PLA), left ventricular pressure (PLV), left ventricular end-diastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). Myocardial oxygen consumption (EG) was calculated according to the method of Bretschneider. There was almost no change in cardiac index and stroke index. In comparison to a control group (n=36) morphine caused a dose-dependent decrease in arterial pressure and in arterial perfusion pressure during extracorporeal circulation. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect. In accordance with the changes in haemodynamics there was a remarkable decrease in myocardial oxygen consumption (EG: -21.1%; 1,0 mg/kg morphine).

We have investigated the use of M-mode echocardiography for the diagnosis of aortic valve stenosis by application of the Gorlin formula. The hemodynamic parameters which enter this formula are shown to derive wholly from noninvasive measurements. The predicted valve areas correspond with those derived by classical catheterization studies at a level of r = 0.89, SE = 0.11 cm2, n = 10. These results suggest that the Gorlin formula for aortic stenosis may have application in a noninvasive context.

In 30 patients with congenital or acquired heart disease the haemodynamic effects of diazepam (Valium) 0.3 mg/kg were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: Heart rate (HR), arterial pressure (-Part, Psyst, Pdiast), pulmonary artery pressure (-PAP), right (-PRA) and left atrial pressure (-PLA), left ventricular pressure (PLV), left ventricular enddiastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). In comparison with a control group (n = 36) diazepam caused a decrease in arterial pressure cardiac index, stroke index, right and left atrial pressure and dp/dtmax. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect, which is of only minor importance with diazepam. These haemodynamic changes resulted in a reduction in myocardial oxygen consumption. Diazepam is a valuable drug in neuroleptanalgesia, when an increase in blood pressure can not be controlled by fentanyl or droperidol.

The influence of a combination of fentanyl (0.1 mg) and etomidate (0,15 mg/kg and 0.3 mg/kg) on haemodynamics, inotropic state, myocardial oxygen consumption and vascular reaction has been investigated in 60 patients with congenital or acquired heart diseases--mostly functional class III according to NYHAC. Because of minor changes in haemodynamics (decrease in mean arterial pressure, left ventricular pressure, peak dp/dt, cardiac index, stroke index) the combination of 0.15 mg/kg etomidate and 0.1 mg fentanyl seems to be of great value for induction of anaesthesia in patients with cardiac disease compared to other intravenous induction agents such as propanidid, thiopentone or althesin. In accordance with the changes in haemodynamics there was a 12% and 18% decrease in myocardial oxygen consumption, respectively.

In 93 patients (ASA I) undergoing orthopaedic operations respiratory and haemodynamic effects of alfentanil (steady state: spontaneous breathing halothane, N2O/O2) were measured. After injection of alfentanil apnoea was found be readily antagonized by Naloxone. A significant decrease of arterial pressure and heart rate occurred simultaneously independent of dose level. The decrease of arterial pressure could be prevented by pre-injection of atropine. Therefore an increased vagal tone must be responsible for depression of haemodynamic parameters.