Effect of Sevoflurane Anesthesia on Diastolic Function: A Prospective Observational Study.

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia Pub Date : 2024-09-01 Epub Date: 2024-02-27 DOI:10.1213/ANE.0000000000006924

Sang Hyun Lee, Hyun Joo Ahn, Gyeong Min Kim, MiKyung Yang, Jie Ae Kim, Sangmin M Lee, Burn Young Heo, Ji Won Choi, Jin Young Lee, Heejoon Jeong, Jeayoun Kim

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Abstract

Background: The effect of sevoflurane on left ventricular diastolic function is not well understood. We hypothesized that parameters of diastolic function may improve under sevoflurane anesthesia in patients with preexisting diastolic dysfunction compared to patients with normal diastolic function.

Methods: This observational study included 60 patients undergoing breast surgery or laparoscopic cholecystectomy. Patients were assigned to diastolic dysfunction (n = 34) or normal (n = 26) groups of septal e' < 8 or ≥ 8.0 cm/s on the first thoracic echocardiography (TTE) performed before anesthesia. During anesthesia, sevoflurane was maintained at 1 to 2 minimum alveolar concentration (MAC) to maintain the bispectral index at 40 to 50. At the end of surgery, the second TTE was performed under 0.8 to 1 MAC of sevoflurane with the patient breathing spontaneously without ventilator support. Primary end point was the percentage change (Δ) of e' on 2 TTEs (Δe'). Secondary end points were ΔE/e', Δleft atrial volume index (ΔLAVI), and Δtricuspid regurgitation maximum velocity (ΔTR Vmax). These percentage changes (Δ) were compared between diastolic dysfunction and normal groups.

Results: e' (Δe': 30 [6, 64] vs 0 [-18, 11]%; P < .001), mitral inflow E wave velocity (E), mitral inflow E/A ratio (E/A), and mitral E velocity deceleration time (DT) improved significantly in diastolic dysfunction group compared to normal group. LAVI decreased in diastolic dysfunction group but did not reach statistical significance between the 2 groups (ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%, P = .091). ΔE/e' was not different between the 2 groups (11 [-16, 26] vs 12 [-9, 22]%, P = .853) (all: median [interquartile range, IQR]). TR was minimal in both groups.

Conclusions: In this study, echocardiographic parameters of diastolic function, including septal e', E, E/A, and DT, improved with sevoflurane anesthesia in patients with preexisting diastolic dysfunction, but remained unchanged in patients with normal diastolic function.

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七氟醚麻醉对舒张功能的影响：前瞻性观察研究

背景：七氟醚对左心室舒张功能的影响尚不十分清楚。我们假设，与舒张功能正常的患者相比，已经存在舒张功能障碍的患者在七氟醚麻醉下的舒张功能参数可能会有所改善：这项观察性研究包括 60 名接受乳房手术或腹腔镜胆囊切除术的患者。患者在麻醉前进行的第一次胸部超声心动图（TTE）检查中，室间隔e'< 8或≥ 8.0 cm/s，被分配到舒张功能障碍组（34人）或正常组（26人）。麻醉期间，七氟醚的最小肺泡浓度（MAC）保持在 1 到 2，以将双频谱指数维持在 40 到 50。手术结束时，在 0.8 至 1 MAC 的七氟烷浓度下进行第二次 TTE，患者在没有呼吸机支持的情况下自主呼吸。主要终点是两次 TTE 的 e' 百分比变化 (Δ)（Δe'）。次要终点为ΔE/e'、Δ左房容积指数（ΔLAVI）和Δ三尖瓣反流最大速度（ΔTR Vmax）。结果：与正常组相比，舒张功能障碍组的 E'（Δe'：30 [6, 64] vs 0 [-18, 11]%；P < .001）、二尖瓣流入道 E 波速度（E）、二尖瓣流入道 E/A 比值（E/A）和二尖瓣 E 波速度减速时间（DT）均有显著改善。舒张功能障碍组的 LAVI 有所下降，但两组之间没有统计学意义（ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%，P = .091）。两组间的ΔE/e'无差异（11 [-16, 26] vs 12 [-9, 22]%，P = .853）（所有数据：中位数[四分位间范围，IQR]）。两组的 TR 都很小：在这项研究中，舒张功能的超声心动图参数，包括室间隔 e'、E、E/A 和 DT，在对已有舒张功能障碍的患者进行七氟醚麻醉后有所改善，但在舒张功能正常的患者中则保持不变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesia and analgesia 医学-麻醉学

CiteScore

9.90

自引率

7.00%

发文量

817

审稿时长

2 months

期刊介绍： Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.