PERIPHERAL VASCULAR EFFECTS OF THIOPENTAL AND PROPOFOL IN HUMANS WITH ARTIFICIAL HEARTS

The peripheral vascular effects of thiopental 5 mg/kg and propofol 2.5 mg/kg were compared in five patients whose lungs were being ventilated and in whom a Jarvik-7 artificial heart had been implanted. The patients were monitored, using catheters that had been surgically inserted into the radial artery, the right and left atria, and the pulmonary artery. The Jarvik-7 settings were modified to render the artificial heart "preload independent" and to maintain cardiac output constant. Each patient received both drugs, with the interval between each drug ranging from 16 to 28 h. Hemodynamic parameters and catecholamine and atrial natriuretic peptide plasma concentrations were measured before drug administration and 5, 10, 15, 30, and 45 min later. Both drugs significantly decreased arterial pressure, systemic vascular resistance index, pulmonary arterial pressure (PAP), and right and left atrial pressures (RAP and LAP, respectively). However, propofol 2.5 mg/kg induced a significantly greater and more prolonged decrease in arterial pressure, systemic vascular resistance index, and RAP than that after administration of thiopental 5 mg/kg (P < 0.05). Five minutes after drug injection, mean arterial pressure decreased by 21 % after thiopental and by 39% after propofol (P < 0.01); systemic vascular resistance index decreased by 21 % after thiopental and by 44% after propofol (P < 0.05); RAP decreased by 20% after thiopental and by 50% after propofol (P < 0.05); mean PAP decreased by 18% after thiopental and by 32% after propofol (P < 0.09); and LAP decreased by 40% after thiopental and by 46% after propofol (P < 0.2). With both drugs, atrial natriuretic peptide, norepinephrine, and epinephrine plasma concentrations remained stable throughout the study period. Because cardiac output was maintained constant throughout the study, these results suggest that propofol 2.5 mg/kg is a more potent vasodilator of venous and arterial beds than is thiopental 5 mg/kg.