{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:24:49Z","timestamp":1787019889792,"version":"build-2736575974"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2009,9,8]],"date-time":"2009-09-08T00:00:00Z","timestamp":1252368000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2009,9,8]],"date-time":"2009-09-08T00:00:00Z","timestamp":1252368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The current debate about the side effects of induction agents, e.g. possible adrenal suppression through etomidate, emphasizes the relevance of choosing the correct induction agent in septic patients. However, cardiovascular depression is still the most prominent adverse effect of these agents, and might be especially hazardous in septic patients presenting with a biventricular cardiac dysfunction - or so-called septic cardiomyopathy. Therefore, we tested the dose-response direct cardiac effects of clinically available induction agents in an isolated septic rat heart model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A polymicrobial sepsis was induced via cecal ligation and single puncture. Hearts (n = 50) were isolated and randomly assigned to five groups, each receiving etomidate, s(+)-ketamine, midazolam, propofol, or methohexitone at concentrations of 1 \u00d7 10\n                      <jats:sup>-8<\/jats:sup>\n                      to 1 \u00d7 10\n                      <jats:sup>-4<\/jats:sup>\n                      M. Left ventricular pressure, contractility and lusitropy, and coronary flow were measured. Cardiac work, myocardial oxygen delivery, oxygen consumption, and percentage of oxygen extraction were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All of the induction agents tested showed a dose-dependent depression of cardiac work. Maximal cardiac work dysfunction occurred in the rank order of s(+)-ketamine (-6%) &lt;etomidate (-17%) &lt;methohexitone (-31%) &lt;midazolam (-38%) &lt;propofol (-50%). In addition, propofol showed a maximum decrease in contractility of -38%, a reduction in lusitropy of -44%, and a direct vasodilator effect by increasing coronary flow by +29%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, this study demonstrates that these tested drugs indeed have differential direct cardiac effects in the isolated septic heart. Propofol showed the most pronounced adverse direct cardiac effects. In contrast, S(+)ketamine showed cardiovascular stability over a wide range of concentrations, and might therefore be a beneficial alternative to etomidate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/cc8038","type":"journal-article","created":{"date-parts":[[2009,9,8]],"date-time":"2009-09-08T15:48:11Z","timestamp":1252424891000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Cardiac effects of induction agents in the septic rat heart"],"prefix":"10.1186","volume":"13","author":[{"given":"York A","family":"Zausig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Busse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Lunz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Sinner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Zink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard M","family":"Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2009,9,8]]},"reference":[{"key":"7469_CR1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1097\/01.CCM.0000298158.12101.41","volume":"36","author":"RP Dellinger","year":"2008","unstructured":"Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.\n                           Crit Care Med 2008, 36: 296-327.","journal-title":"Crit Care Med"},{"issue":"Suppl 1","key":"7469_CR2","first-page":"43","volume":"55","author":"K Reinhart","year":"2006","unstructured":"Reinhart K, Brunkhorst F, Bone H, Gerlach H, Grundling M, Kreymann G, Kujath P, Marggraf G, Mayer K, Meier-Hellmann A, Peckelsen C, Putensen C, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Werdan K: [Diagnosis and therapy of sepsis: guidelines of the German Sepsis Society Inc. and the German Interdisciplinary Society for Intensive and Emergency Medicine].\n                           Anaesthesist 2006,55(Suppl 1):43-56.","journal-title":"Anaesthesist"},{"key":"7469_CR3","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s00134-004-2550-8","volume":"31","author":"G Malerba","year":"2005","unstructured":"Malerba G, Romano-Girard F, Cravoisy A, Dousset B, Nace L, Levy B, Bollaert PE: Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation.\n                           Intensive Care Med 2005, 31: 388-392.","journal-title":"Intensive Care Med"},{"key":"7469_CR4","doi-asserted-by":"publisher","first-page":"R56","DOI":"10.1186\/cc5916","volume":"11","author":"DC Ray","year":"2007","unstructured":"Ray DC, McKeown DW: Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock.\n                           Crit Care 2007, 11: R56.","journal-title":"Crit Care"},{"key":"7469_CR5","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/j.1365-2044.1986.tb12740.x","volume":"41","author":"JS McCollum","year":"1986","unstructured":"McCollum JS, Dundee JW: Comparison of induction characteristics of four intravenous anaesthetic agents.\n                           Anaesthesia 1986, 41: 995-1000.","journal-title":"Anaesthesia"},{"key":"7469_CR6","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1213\/00000539-199204000-00015","volume":"74","author":"DF Stowe","year":"1992","unstructured":"Stowe DF, Bosnjak ZJ, Kampine JP: Comparison of etomidate, ketamine, midazolam, propofol, and thiopental on function and metabolism of isolated hearts.\n                           Anesth Analg 1992, 74: 547-558.","journal-title":"Anesth Analg"},{"key":"7469_CR7","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1097\/00003246-199010000-00028","volume":"18","author":"JE Parrillo","year":"1990","unstructured":"Parrillo JE: Myocardial depression during septic shock in humans.\n                           Crit Care Med 1990, 18: 1183-1184.","journal-title":"Crit Care Med"},{"key":"7469_CR8","first-page":"226","volume":"11","author":"U Muller-Werdan","year":"2006","unstructured":"Muller-Werdan U, Buerke M, Ebelt H, Heinroth KM, Herklotz A, Loppnow H, Russ M, Schlegel F, Schlitt A, Schmidt HB, Schmidt HB, Soffker G, Werdan K: Septic cardiomyopathy - 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