Background The 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.

Objective Determining 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)

Design Prospective study, analytical observational with multivariate linear regression analysis, and multicenter study

Setting 2 hospitals, including 1 teaching hospital and 1 private hospital

Patients all patients who underwent cardiopulmonary bypass surgery and are eligible for the inclusion criteria

Measurements Doses 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 induction

Results These 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 R2 0.9231 and p-value 0.88, 2. the effect size of ejection fraction value ≥ 50% on BIS index obtained R2 0.7794 and p-value 0.01, 3. the effect size of ejection fraction value < 50% on mean arterial pressure obtained R2 0.00024 and p-value 0.97, 4. The effect size of ejection fraction value ≥ 50% on mean arterial pressure obtained R2 0.0786 and p-value 0.005, 5. The effect size of ejection fraction value < 50% on heart rate obtained R2 0.3992 and p-value 0.06, 6. The effect size of ejection fraction value ≥ 50% on heart rate obtained R2 0.1757 and p-value 7.0776e-04.

Conclusions Propofol 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

The authors have declared no competing interest.

The author declares no funding was received

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I confirm all relevant ethical guidelines have been followed. The Research Ethic Committee of Premier Hospital, Surabaya, Indonesia, has approved this observational study with the protocol number of 01/rps/kers/1/2022, and approval by The Research Ethic Committee of Dr.Soetomo General Hospital, Surabaya, Indonesia, with the protocol number of 0442/KEPK/VII/2022

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