A randomised controlled trial comparing the effects of propofol with isoflurane in patients with diastolic dysfunction undergoing coronary artery bypass graft surgery

Abstract

There is a strong association between pre-operative diastolic dysfunction and difficulty in weaning from cardiopulmonary bypass. We compared the effects of propofol and isoflurane on left ventricular diastolic function in patients with pre-existing diastolic dysfunction undergoing coronary artery bypass grafting. We randomly allocated 60 patients to receive either propofol or isoflurane anaesthesia, and assessed left ventricular diastolic function using transoesophageal echocardiography. We measured early (E), late (A) diastolic velocities, E/A ratio, A-wave duration and deceleration time using pulsed wave Doppler, and early (Em), late (Am) diastolic velocities of the mitral annulus, Em/Am ratio and isovolumetric relaxation time using tissue Doppler. We measured pulmonary venous flow velocity and recorded values for the peak systolic flow velocity (S), peak diastolic flow velocity (D), S/D ratio, peak reverse atrial flow velocity and duration of reverse atrial flow. All data were recorded immediately after tracheal intubation as a baseline, 5 min before sternotomy (T ), 5 min before aortic cannulation (T ) and 15 min after weaning from cardiopulmonary bypass (T ). Both propofol and isoflurane improved left ventricular diastolic function as evidenced by significant increases in E/A ratios, and significant decreases in deceleration time and isovolumetric relaxation time; the improvement was greater in the isoflurane group (between groups, p = 0.001 for both E/A ratio and deceleration time at T and T and p = 0.006 for isovolumetric relaxation time at both T and T ). Furthermore, Em/Am ratio, S, D and S/D ratios were significantly better in the isoflurane group. The administration of isoflurane during cardiac surgery improves diastolic function comparatively more than propofol.

TAPB and RSB protects cardiac diastolic function in elderly patients undergoing abdominopelvic surgery: a retrospective cohort study

“…However, many clinical studies have shown that patients with left ventricular diastolic dysfunction before anesthesia could be improved by using isoflurane, desflurane, or sevoflurane owing to reducing the after-load of the left ventricle to achieve a normal filling pattern (Sarkar, GuhaBiswas & Rupert, 2010). Ammar, A. reported that isoflurane was favourable over propofol on diastolic dysfunction (Ammar et al, 2016). It was possible that anesthetic agents could alter sarcoplasmic reticulum calcium homeostasis at the sarcoplasmic reticulum, a pivotal component of normally myocardial relaxation (Pagel et al, 1993).…”

“…Hemodynamics, variation of cardiac preload and afterload, was not a neglectable factor affecting diastolic function measurement, regardless of increase or decrease (Ammar et al, 2016). Accordingly, managing pro-load by monitoring CVP and managing after-load by controlling HR and MAP were applied to reduce the impact of hemodynamics on diastolic function measurement.…”

“…The need for consent was waived for this study, as data was previously collected as part of regular hospital procedures and all patients previously consented to data collection prior to surgery. Patients were contacted (Ammar et al, 2016;Matyal et al, 2011). The hemodynamics stability was that hemodynamic values were maintained between 15% pre-induction baseline values.…”

“…Different anesthetics cause various degrees of inhibition of diastolic function (Sarkar, GuhaBiswas & Rupert, 2010;Ammar et al, 2016;Lee et al, 2016). Thus, for patients with cardiovascular disease, it is vital to implement appropriate anesthesia maintenance strategies to substantially reduce the impact on heart function as much as possible.…”

The results of standard echocardiography and use of Velocity Vector Imaging technology after surgical revascularization in patients with coronary artery disease

“…Действительно, спустя 6, 12 и 24 мес были выявлены пациенты с различными жалобами, в том числе связанными с дискомфортом за грудиной, однако были и те, кто отмечал стойкие подъемы артериального давления. Следует отметить, что в ранние сроки после КШ может наблюдаться улучшение ДФ ЛЖ, связанное с влиянием ингаляционной анестезии на параметры релаксации миокарда [19,20]. Возврат к дооперационным значениям может быть связан с наличием у пациентов сопутствующей артериальной гипертензии (39 (97%)), а ухудшение или переход в другой тип дисфункции должен сопровождаться комплексным обследованием.…”