Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction

Filipovic, Miodrag; Michaux, Isabelle; Wang, J.; Hunziker, Patrick; Skarvan, K.; Seeberger, Manfred D.

doi:10.1093/bja/ael277

Cited by 46 publications

(37 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The physiologic effects of general anaesthesia and positive pressure ventilation on LV cavity size were recently demonstrated in a magnetic resonance imaging study in healthy adults (10) and several echocardiographic studies in healthy subjects and in patients with cardiac disease (9,(31)(32)(33). All these studies reported that LV cavity dimensions were reduced during anaesthesia and positive pressure ventilation, most likely as a consequence of decreased venous return and LV preload.…”

Section: Discussionmentioning

confidence: 89%

“…However, such values might not necessarily apply for patients with coronary heart disease. Further, even if normative values obtained using transoesophageal echocardiography (TOE) in awake subjects are applied (6,7), anaesthetic drugs, positive pressure ventilation and patient positioning may have systematic effects on cardiac function and loading conditions causing small, but important differences in LV EDA and EDD measurements in the anaesthetised and ventilated patients (8)(9)(10). Finally, TTE values might be different from those for TOE as a consequence of small differences in the position of the echo probe and the slightly different standard echocardiographic cross-sectional views used in the two techniques (11).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

Bolliger¹,

Poltera²,

Cheung³

et al. 2018

Turk J Anaesth Reanim

View full text Add to dashboard Cite

Objective: Normative values for left ventricular (LV) end-diastolic area (EDA) and diameter (EDD) for intra-operative transoesophageal echocardiography (TOE) have not been established. We aimed to define the ranges of LV EDA and EDD for intra-operative TOE examinations in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A MEDLINE search for studies reporting LV EDA and EDD in patients undergoing CABG surgery was performed. Individual-level data set from 333 anaesthetised and ventilated patients with preserved LV function (study population) was obtained from eight studies. EDA and calculated EDD in the study population were compared with summary EDD values obtained using transthoracic echocardiography (TTE) in two studies of 500 awake patients with coronary artery disease (CAD). Further, the influence of pre-specified factors on EDD was evaluated in a multivariate regression model. Results: The EDA and EDD values measured using TOE in the anaesthetised CABG patients were 16.7±4.7 cm 2 and 4.6±0.6 cm, respectively. TOE values of EDD in anaesthetised patients were 10%-13% less than those measured using TTE in two studies of awake patients (p<0.001). Body surface area, age and fractional area change, but not sex were factors that affected LV EDD. Conclusion:The values for LV EDD measured through intra-operative TOE in anaesthetised ventilated CABG patients were 10%-13% less than the corresponding values measured using TTE in awake CAD patients. This finding indicates that independent normative values specific for intra-operative TE should be established for guiding intra-operative clinical decisions. Keywords: Echocardiography, transthoracic echocardiography, transesophageal echocardiography, cross-sectional, coronary artery bypass surgery Amaç: İntraoperatif transözofajiyal ekokardiyografi (TOE) için sol ventrikül (SV) diyastol sonu alanı (EDA) ve çapının (EDD) normal değerleri belirlenmemiştir. Bu çalışmanın amacı, koroner arter bypass greft (KABG) ameliyatı geçiren hastalarda yapılan intraoperatif TOE incelemeleri için SV EDA ve EDD aralıklarını tanımlamaktır. Yöntemler: KABG ameliyatı geçiren hastalarda SV EDA ve EDD değerlerini rapor eden çalışmalar için bir MEDLINE araştırması yapıldı. Korunmuş SV fonksiyonu olan 333 anestezi ve ventilasyon uygulanmış hastanın (çalışma popülasyonu) bireysel verileri 8 çalışmadan elde edildi. Çalışma popülasyonundaki EDA ve hesaplanmış EDD değerleri, koroner arter hastalığı (KAH) olan 500 bilinçli hastayı içeren iki çalışmada transtorasik ekokardiyografi (TTE) kullanarak elde edilen özet EDD değerleri ile karşılaştırıl-dı. Ayrıca, önceden belirlenmiş faktörlerin EDD üzerindeki etkisi multivaryant regresyon modeli kullanılarak değerlendirildi. Bulgular: Anestezi altındaki KABG hastalarında TOE kullanılarak ölçülen EDA ve EDD değerleri sırasıyla 16,7±4,7 cm 2 ve 4,6±0,6 cm olarak bulundu. Anestezi uygulanan hastalarda TOE ve EDD değerleri, bilinçli hastalar üzerinde yapılan iki çalışmada TTE kullanılarak ölçülen değerlere göre %10-%13 daha düşüktü (p<0,00...

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

Bolliger¹,

Poltera²,

Cheung³

et al. 2018

Turk J Anaesth Reanim

View full text Add to dashboard Cite

show abstract

“…Anesthesia was maintained with sevoflurane in the majority of the patients (84%), whereas anesthesia was maintained with propofol in the remaining patients. Filipovic et al [25] reported no differences in E m , A m , or S m between the sevoflurane and propofol groups with intermittent positive pressure ventilation. On this basis, we consider that the choice of the anesthetic agents in our study did not affect the TDI variables.…”

Section: Discussionmentioning

confidence: 96%

Tissue Doppler imaging is useful for predicting the need for inotropic support after cardiac surgery

et al. 2011

View full text Add to dashboard Cite

show abstract

“…In animal studies [32,33], propofol has not been found to affect diastolic function. Filipovic et al [34] randomised 20 patients to sevoflurane and 20 to propofol undergoing minor surgery. Echocardiography was performed pre-operatively, during induction of anaesthesia and following mechanical ventilation of the lungs.…”

Section: Discussionmentioning

confidence: 99%

Analysis of transthoracic echocardiographic data in major vascular surgery from a prospective randomised trial comparing sevoflurane and fentanyl with propofol and remifentanil anaesthesia

et al. 2014

View full text Add to dashboard Cite

SummaryThe aim of this study was to define pre-operative echocardiographic data and explore if postoperative indices of cardiac function after open abdominal aortic surgery were affected by the anaesthetic regimen. We hypothesised that volatile anaesthesia would improve indices of cardiac function compared with total intravenous anaesthesia. Transthoracic echocardiography was performed pre-operatively in 78 patients randomly assigned to volatile anaesthesia and 76 to total intravenous anaesthesia, and compared with postoperative data. Pre-operatively, 16 patients (10%) had left ventricular ejection fraction < 46%. In 138 patients with normal left ventricular ejection fraction, 5/8 (62%) with left ventricular dilatation and 41/130 (33%) without left ventricular dilatation had evidence of left ventricular diastolic dysfunction (p < 0.001). Compared with pre-operative findings, significant increases in left ventricular enddiastolic volume, left atrial maximal volume, cardiac output, velocity of early mitral flow and early myocardial relaxation occurred postoperatively (all p < 0.001). The ratio of the velocity of early mitral flow to early myocardial relaxation remained unchanged. There were no significant differences in postoperative echocardiographic findings between patients anaesthetised with volatile anaesthesia or total intravenous anaesthesia. Patients had an iatrogenic surplus of approximately 4.1 l of fluid volume by the first postoperative day. N-terminal prohormone of brain natriuretic peptide increased on the first postoperative day (p < 0.001) and remained elevated after 30 days (p < 0.001) in both groups. Although postoperative echocardiographic alterations were most likely to be related to increased preload due to a substantial iatrogenic surplus of fluid, a component of peri-operative myocardial ischaemia cannot be excluded. Our hypothesis that volatile anaesthesia improved indices of cardiac function compared with total intravenous anaesthesia could not be verified.

show abstract

Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction

Abstract: During spontaneous breathing, early diastolic function improved in the sevoflurane but not in the propofol group. However, during positive pressure ventilation and balanced anaesthesia, there was no evidence of different effects caused by the two anaesthetics.

Cited by 46 publications

References 31 publications

Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

Tissue Doppler imaging is useful for predicting the need for inotropic support after cardiac surgery

Analysis of transthoracic echocardiographic data in major vascular surgery from a prospective randomised trial comparing sevoflurane and fentanyl with propofol and remifentanil anaesthesia

Contact Info

Product

Resources

About