J Korean Med Sci.  2018 Jan;33(4):e28. 10.3346/jkms.2018.33.e28.

Isoflurane's Effect on Intraoperative Systolic Left Ventricular Performance in Cardiac Valve Surgery Patients

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea. taeyop@gmail.com
  • 3Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea.
  • 4Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
  • 5Cardiothoracic Anaesthesiology and Perfusion Unit, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Sarawak, Malaysia.
  • 6Department of Anesthesiology, Chung-Ang University School of Medicine, Seoul, Korea.
  • 7Department of Anesthesiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 8Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.

Abstract

BACKGROUND
Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined isoflurane's direct impact on the left ventricular (LV) contractile function during cardiac surgery. We determined whether isoflurane dose-dependently reduces the peak systolic velocity of the lateral mitral annulus in tissue Doppler imaging (S"²) in patients undergoing cardiac surgery.
METHODS
During isoflurane-supplemented remifentanil-based anesthesia for patients undergoing cardiac surgery with preoperative LV ejection fraction greater than 50% (n = 20), we analyzed the changes of S"² at each isoflurane dose increment (1.0, 1.5, and 2.0 minimum alveolar concentration [MAC]: T1, T2, and T3, respectively) with a fixed remifentanil dosage (1.0 μg/min/kg) by using transesophageal echocardiography.
RESULTS
Mean S"² values (95% confidence interval [CI]) at T1, T2, and T3 were 10.5 (8.8-12.2), 9.5 (8.3-10.8), and 8.4 (7.3-9.5) cm/s, respectively (P < 0.001 in multivariate analysis of variance test). Their mean differences at T1 vs. T2, T2 vs. T3, and T1 vs. T3 were −1.0 (−1.6, −0.3), −1.1 (−1.7, −0.6), and −2.1 (−3.1, −1.1) cm/s, respectively. Phenylephrine infusion rates were significantly increased (0.26, 0.22, and 0.47 μg/kg/min at T1, T2, and T3, respectively, P < 0.001).
CONCLUSION
Isoflurane increments (1.0-2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.

Keyword

Echocardiography; Heart function test; Isoflurane

MeSH Terms

Anesthesia
Echocardiography
Echocardiography, Transesophageal
Heart Function Tests
Heart Valves*
Humans
Isoflurane
Multivariate Analysis
Phenylephrine
Thoracic Surgery
Isoflurane
Phenylephrine
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