[Propofol in the surgery of the aortic bifurcation. Comparison with isoflurane]. / Le propofol dans la chirurgie du carrefour aortique. Comparaison avec l'isoflurane.

Two groups of nine patients each, all undergoing surgery for aorto-bifemoral prosthesis, were studied. They were premedicated with 10 mg morphine and 1 mg flunitrazepam. A Swan-Ganz catheter was then inserted. Cardiac output was measured by thermodilution. Haemodynamic parameters were measured before induction (t0), 15 min after intubation (t1), 10 min after the start of the surgical procedure (t2), 5 min before clamping the aorta (t3), whilst the aorta was clamped (t4), and a few minutes after unclamping. Group A received 2 mg X kg-1 propofol at induction, anaesthesia being maintained with 100 micrograms X kg-1 X min-1 propofol. Group B received 4 mg X kg-1 thiopentone, followed by isoflurane at the dose of 0.9 vol. %. Both groups received 5 micrograms X kg-1 fentanyl and 0.1 mg X kg-1 vecuronium to ease intubation. Artificial respiration was carried out with a mixture of 40% oxygen and 60% nitrous oxide. The fall in blood pressure between t2 and t3 was significantly more important in the propofol group (-16%). In the same group, the systolic blood pressure and heart rate fell by 23 and 19% respectively after induction (p less than 0.05); the cardiac index fell by 20% and the systemic vascular resistances did not change. The fall in blood pressure, heart rate and cardiac index were not significant for group B. The haemodynamic changes due to clamping of the aorta were not significant between or within groups. In group A, one patient presented with bradycardia, hypotension and myocardial ischaemia, and another died of postoperative ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)