Multivariate Analysis for the Influence of Ejection Fraction Value on Propofol Anesthesia Induction Requirement and its Pharmacodynamic Properties in Cardiopulmonary Bypass Surgery (Observational Study based on the Clinical Outcomes)

Abstract

BackgroundThe majority of propofol utilization as an induction anesthetic in cardiac surgery, particularly in cardiopulmonary bypass surgery led to several risks to the patient. The most common risk is dropped mean arterial pressure, even with the high risk of cardiac arrest.ObjectiveDetermining the influences of ejection fraction value on the amount of propofol requirement as an induction agent based on the patient’s primary outcome (BIS spectral index) and the secondary outcomes (mean arterial pressure and heart rate)DesignProspective study, analytical observational with multivariate linear regression analysis, and multicenter studySetting2 hospitals, including 1 teaching hospital and 1 private hospitalPatientsall patients who underwent cardiopulmonary bypass surgery and are eligible for the inclusion criteriaMeasurementsDoses of Propofol as an anesthesia induction, mean arterial pressure (MAP) prior to surgery, heart rate (HR) prior to surgery, BIS Spectral Index prior to surgery, MAP after induction, HR after induction, and BIS Spectral Index after inductionResultsThese data were analyzed using MATLAB R2022a software to obtain R2(determining the effect size or influences) and p-value for each condition of ejection fraction value and the clinical responses. The data of this observational study is divided into six groups : 1. the effect size of ejection fraction value < 50% on BIS index obtained R20.9231 and p-value 0.88, 2. the effect size of ejection fraction value ≥ 50% on BIS index obtained R20.7794 and p-value 0.01, 3. the effect size of ejection fraction value < 50% on mean arterial pressure obtained R20.00024 and p-value 0.97, 4. The effect size of ejection fraction value ≥ 50% on mean arterial pressure obtained R20.0786 and p-value 0.005, 5. The effect size of ejection fraction value < 50% on heart rate obtained R20.3992 and p-value 0.06, 6. The effect size of ejection fraction value ≥ 50% on heart rate obtained R20.1757 and p-value 7.0776e-04.ConclusionsPropofol extremely impacts BIS index value compared to the patient’s mean arterial pressure or heart rate at the induction doses of propofol in general anesthesia for patients with a reduced ejection fraction