Comparative Assessment of the Cardiodepressive Effect in Traditional and Modified Induction Schemes of Anesthesia in Elderly Patients with Ischemic Heart Disease

most anesthetic drugs have a cardiodepressant action, which in elderly patients leads to a greater inhibition of the contractile functions of cardiomyocytes. Reducing the cardiodepressant action during the induction of anesthesia in elderly patients can reduce the incidence of peri- and postoperative complications and improve the safety of anesthesia in this category of patients. The aim of the study was to improve the safety of anesthesia in elderly patients with ischemic heart disease (IHD) by determining and applying an induction scheme with minimal cardiodepressant action. We examined 40 patients over 60 (in group 1, propofol and fentanyl were used for induction; in group 2, propofol, fentanyl, ketamine). Hemodynamic parameters were recorded at the following stages: 1) upon delivery of the patient to the operating room; 2) after administration of induction drugs; 3) after intubation; 4) 25 minutes after tracheal intubation. The echocardiography data were used to calculate the stroke volume index (SVI) and cardiac index (CI). It was found that upon delivery of patients to the operating room, the values of hemodynamic parameters indicated the stability of the overall health status of patients (SVI was 31.99 ± 3.91 ml/m2 for group 1 and 32.19 ± 4.29 ml/m2 for group 2; СI was 2.49 ± 0.32 l/min/m2 for group 1 and 2.44 ± 0.39 l/min/m2 for group 2). After the administration of drugs for induction, a decrease in the indicators characterizing the contractility of the myocardium was recorded compared with the baseline: SVI was 90.7 ± 3.71% for group 1, 89.9 ± 5.86% for group 2, CI was 81.5 ± 6.6% for group 1, 85.63 ± 10.17% for group 2. There were no statistically significant differences in these indicators between the groups. After insertion of the intubation tube, a significant difference (p < 0.05) between the groups was noted in the indicators of SVI (99.91 ± 2.5% for group 1, 109.6 ± 8.16% for group 2 of the initial values) and CI (96.63 ± 11.8% for group 1, 110.38 ± 12.37% for group 2 of the initial values). In 25 minutes after intubation, statistically significant differences between the groups were observed in the parameters of SVI (87.09 ± 5.3% for group 1, 108.21 ± 8.32% for group 2; CI (79.59 ± 10.11% for group 1, 108.29 ± 9.95% for group 2). Thus, it has been demonstrated that the addition of ketamine to the combination of propofol + fentanyl prevents a decrease in myocardial contractility during induction into anesthesia in patients of the older age group.