DOBUTAMINE STRESS ECHOCARDIOGRAPHY TO DETECT INDUCIBLE DEMAND ISCHEMIA IN ANESTHETIZED PATIENTS WITH CORONARY-ARTERY DISEASE

Background: A cardiac risk stratification test that can be performed d uring operation would be expected to give valuable information for the therapeutic management of patients who need urgent noncardiac surgery . This study was designed to evaluate the feasibility and safety of a dobutamine-atropine stress protocol to detect inducible demand ischemi a in anesthetized patients. Methods: A standard dobutamine-atropine st ress protocol was performed in 80 patients with severe coronary artery disease during fentanyl-isoflurane anesthesia. Biplane transesophagea l echocardiography and 12-lead electrocardiography were used to detect induced ischemia. After dobutamine testing, esmolol, nitroglycerin, o r both were used to revert ischemia and any hemodynamic changes, as ap propriate. Results: The protocol detected inducible ischemia or achiev ed the target heart rate in 75 of the 80 (94%) patients. None of the p rospectively defined adverse outcomes, such as cardiovascular collapse , severe ventricular arrhythmia, persistent (greater than or equal to 5 min) ischemia, or hemodynamic instability, occurred in any of the pa tients. Ischemia was induced and detected in 73 of the 80 (91%) patien ts. Conclusion: Dobutamine stress echocardiography is feasible in anes thetized patients with severe coronary artery disease. The lack of ser ious complications and the high sensitivity to detect inducible ischem ia in this patient population provide the basis for further evaluation of the safety and diagnostic value of dobutamine stress echocardiogra phy during general anesthesia in larger studies of patients at risk fo r coronary artery disease undergoing noncardiac surgery.