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

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...

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Published in:	Journal of Korean medical science Vol. 33; no. 4; p. e28
Main Authors:	Kim, Ju Deok, Son, Ilsoon, Kwon, Won Kyoung, Sung, Tae Yun, Sidik, Hanafi, Kim, Karam, Kang, Hyun, Bang, Jiyon, Yeo, Gwi Eun, Lee, Dong Kyu, Kim, Tae Yop
Format:	Journal Article
Language:	English
Published:	Korea (South) The Korean Academy of Medical Sciences 01-01-2018 대한의학회
Subjects:	Original 의학일반 Heart function test Isoflurane Echocardiography
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Abstract	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') in patients undergoing cardiac surgery. 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' 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. Mean S' 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). Isoflurane increments (1.0-2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.
AbstractList	BACKGROUNDIsoflurane, 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') in patients undergoing cardiac surgery.METHODSDuring 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' 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.RESULTSMean S' 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).CONCLUSIONIsoflurane increments (1.0-2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function. 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′) 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′ 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′ 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. KCI Citation Count: 0 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') in patients undergoing cardiac surgery. 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' 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. Mean S' 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). Isoflurane increments (1.0-2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.
Author	Yeo, Gwi Eun Kim, Ju Deok Bang, Jiyon Kim, Karam Kwon, Won Kyoung Kim, Tae Yop Sidik, Hanafi Lee, Dong Kyu Sung, Tae Yun Kang, Hyun Son, Ilsoon
AuthorAffiliation	1 Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea 6 Department of Anesthesiology, Chung-Ang University School of Medicine, Seoul, Korea 8 Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea 2 Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea 4 Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea 3 Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea 5 Cardiothoracic Anaesthesiology and Perfusion Unit, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Sarawak, Malaysia 7 Department of Anesthesiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
AuthorAffiliation_xml	– name: 5 Cardiothoracic Anaesthesiology and Perfusion Unit, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Sarawak, Malaysia – name: 6 Department of Anesthesiology, Chung-Ang University School of Medicine, Seoul, Korea – name: 7 Department of Anesthesiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea – name: 3 Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea – name: 8 Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea – name: 1 Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea – name: 2 Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea – name: 4 Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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CitedBy_id	crossref_primary_10_1053_j_jvca_2020_06_005 crossref_primary_10_1097_FJC_0000000000001448 crossref_primary_10_1177_1089253220936784 crossref_primary_10_1053_j_jvca_2021_05_041
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Snippet	Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined isoflurane's... BACKGROUNDIsoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined... Background: Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined...
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Title	Isoflurane's Effect on Intraoperative Systolic Left Ventricular Performance in Cardiac Valve Surgery Patients
URI	https://www.ncbi.nlm.nih.gov/pubmed/29318795 https://search.proquest.com/docview/1989572938 https://pubmed.ncbi.nlm.nih.gov/PMC5760813 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002310867
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