Cardiovascular effects of etomidate used for induction and in combination with fentanyl-pancuronium for maintenance of anaesthesia in patients with valvular heart disease.

The effects of induction of anaesthesia by etomidate 3 mg kg-1 followed by continuous infusion of etomidate 2 mg min-1, fentanyl 0.01 mg.kg-1 and pancuronium 0.1 mg.kg-1 were studied in ten patients with valvular heart disease. No haemodynamic changes were seen injection of etomidate, but after fentanyl was given there was a significant decline in cardiac index (10%), in mean arterial systemic pressure (20%), in systemic vascular resistance (14%), in left ventricular minute work index (27%) and in right ventricular minute work index (21%) compared to the control values. After supplementing with pancuronium, no further significant changes were seen. There was no significant change in the pulmonary vascular resistance during the whole study. In conclusion, it appears that etomidate is a safe intravenous agent, and is worth further study, in particular in patients with minimal cardiac reserve requiring high inspired oxygen tension.