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ORIGINAL ARTICLE

Comparative analysis of diazepam, midazolam and propofol effects in myocardial contractility

Carlos Geraldo Sobral de MedeirosI; José Carlos Dorsa Vieira PontesI; Otoni Moreira GomesI

DOI: 10.1590/S0102-76381995000400005

ABSTRACT

Cardiac rate, myocardial tension, coronary flow and myocardial contractility (dT/dt) variantions were registered in a population of fourty Wistar rats. In all animals, after ether anesthesia, the hearts were removed and perfused with 95% O2 and 5% CO2 enriched Krebs-Henseleit (K-H) solution, under 90 cm H2O constant pressure and temperature of 37,0 ± 0.5ºC, until complete stabilization, for control values registration. The hearts were distributed into four groups: Group I were perfused with K-H solution, gathering the data of cardiac performance after 1, 3, 5,10,15, 20, 25, and 30 minutes. In the other three groups, these data were also registered in the same times, after they were treated with 50 mcg of diazepam (Group II), 25 mcg of midazolam (Group III) and 25 mcg followed by 50 mcg of propofol (Group IV25 and IV50). The cardiac rate underwent significant variation in the groups estudied except Group II. Myocardial tension varied to a negative degree in the groups, except for Groups I and IV (propofol 50 mcg). In relation to myocardial contractility (dT/dt), except Group I, all groups underwent decreases. The coronary flow exhibited decreases in all groups studied. The observed variations were statistically significant (p<0.05). It is concluded that the drugs tested (diazepam, midazolama and propofol) determine statistically significant decrease of the myocardial contractility, without difference concerning the intensity of depression degree among all studied groups.

RESUMO

A ação depressora dos benzodiazepínicos e do propofol relaciona-se às suas interferências diretas na fibra miocárdica. A presente investigação se propôs analisar a contratilidade miocárdica em coração isolado de ratos tratados com diazepam, midazolam e propofol. Os parâmetros registrados foram: freqüência cardíaca (bpm), tensão miocárdica (g) e fluxo coronariano (ml/min). Além das variações da dT/dtmax, foram também analisadas aquelas ocorridas nos parâmetros acima citados, em grupos constituídos de dez corações. Grupo I: perfundidos durante 30 minutos com solução de Krebs-Hhenseleit (K-H); Grupo II: recebendo 50 mcg de diazepam em 0,1 ml de solução K-H, fazendo-se o registro dos parâmetros 1,3,5,10, 15,20,25 e 30 minutos após; Grupo III diferiu do grupo anterior pela substituição do diazepam por midazolam, na dose de 25 mcg/0,1 ml K-H; Grupo IV: propofol na dose de 25 mcg/0,1 ml K-H, efetuando-se os registros dos parâmetros em 1, 3, 5, 10 e 15 minutos Grupo IV25. Em seguida, nos mesmos corações, infundiu-se propofol na dose de 50 mcg/0,1 ml K-H, obtendo-se aqueles registros nos mesmos tempos acima (Grupo IV50). A análise da contratilidade miocárdica (dT/dtmax) evidenciou decréscimos significativos nos grupos estudados exceto no Grupo I (Controle). As diminuições observadas em g.seg-1 foram: Grupo II (diazepam), de 30,37 ± 7,10 para 21,50 ± 6,03 com redução de 29,21%; Grupo III (midazolam), de 33,62 ± 2,39 para 24,62 ± 7,48, redução de 26,77%; Grupo IV (propofol)25, de 34,55 ± 3,86 para 28,50 ± 5,97, redução de 17,51 % e Grupo IV (propofol)50, de 34,55 ± 3,86 para 27,57 ± 5,86, com redução de 20,20%. Todas as drogas ensaiadas diminuíram a contratilidade miocárdica (dT/dtmax) p<0,05, sem diferença significante entre a intensidade com que cada uma, isoladamente, determinou tal efeito depressor (p>0,05).
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