Affiliations 

  • 1 Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
  • 2 Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea
  • 3 Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
  • 4 Cardiothoracic Anaesthesiology and Perfusion Unit, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Sarawak, Malaysia
  • 5 Department of Anesthesiology, Chung-Ang University School of Medicine, Seoul, Korea
  • 6 Department of Anesthesiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  • 7 Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
J Korean Med Sci, 2018 01 22;33(4):e28.
PMID: 29318795 DOI: 10.3346/jkms.2018.33.e28

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.