Influence of Anesthetics on Cardiac Index and Metabolic Outcomes in Mitral and Aortic Valve Replacement in Adults: A Randomized Clinical Study.

Background: Cardiac index (CI) and metabolic response to surgery are important indicators of the course of the intraoperative period.

Objectives: This study aimed to determine the effect of sevoflurane, isoflurane, and propofol on CI and metabolic outcomes during aortic and mitral valve replacement in adults.

Methods: In this single-center prospective randomized controlled clinical study, a total of 75 patients were randomly assigned into 3 groups according to the type of anesthesia: The propofol group (n = 25), the sevoflurane group (n = 25), and the isoflurane group (n = 25). Cardiac stroke volume (SV) was determined by intraesophageal echocardiography (SV = end-diastolic volume - end-systolic volume). Cardiac output (CO) and CI were calculated according to the formulas. Oxygen consumption during surgery = CI × arteriovenous difference. Indirect calorimetry was used to determine energy expenditure during anesthesia using a spirometry device.

Results: The use of anesthetics did not change CI. Cardiac index decreased from 3 to 2.9 L/min/m² in the propofol group, increased from 3.1 to 3.2 L/min/m² in the sevoflurane group, and decreased from 2.9 to 2.7 L/min/m² in the isoflurane group. Compared to inhaled anesthetics, propofol significantly reduced VO₂ from 179.1 to 135.7 mL/min/m². Propofol reduced energy expenditure from 1483.7 to 1333.5 kcal.

Conclusions: Volatile anesthetics, propofol has practically no effect on CI in an uncomplicated surgery. Anesthesia with propofol is associated with lower VO₂ and better oxygen delivery to tissues. Energy consumption during propofol anesthesia decreases.