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KMID : 0191120180330040028
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Journal of Korean Medical Science
2018 Volume.33 No. 4 p.28 ~ p.28
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Isoflurane's Effect on Intraoperative Systolic Left Ventricular Performance in Cardiac Valve Surgery Patients
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Kim Ju-Deok
Son Il-Soon
Kwon Won-Kyoung
Sung Tae-Yun
Sidik Hanafi
Kim Ka-Ram
Kang Hyun
Bang Ji-Yon
Yeo Gwi-Eun
Lee Dong-Kyu
Kim Tae-Yop
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Abstract
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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.
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KEYWORD
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Echocardiography, Heart function test, Isoflurane
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