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Effects of sevoflurane increments on left ventricular systolic long-axis performance during sevoflurane–remifentanil anesthesia for cardiovascular surgery

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Abstract

Background

The direct impact of sevoflurane on intraoperative left ventricular (LV) systolic performance during cardiac surgery has not been fully elucidated. Peak systolic tissue Doppler velocities of the lateral mitral annulus (S′) have been used to evaluate LV systolic long-axis performance. We hypothesized that incremental sevoflurane concentration (1.0–3.0 inspired-vol%) would dose-dependently reduce S′ in patients undergoing cardiac surgery due to mitral or aortic insufficiency.

Methods

In 20 patients undergoing cardiac surgery in sevoflurane–remifentanil anesthesia, we analyzed intraoperative S′ values which were determined after 10 min exposure to sevoflurane at 1.0, 2.0, and 3.0 inspired-vol% (T1, T2, and T3, respectively) with a fixed remifentanil dose (1.0 μg/kg/min) using transesophageal echocardiography.

Results

Linear mixed-effect modeling demonstrated dose-dependent declines in S′ according to the end-tidal sevoflurane concentration increments (CET-sevoflurane, p < 0.001): the mean value of S′ reduction for each 1.0 vol%-increment of CET-sevoflurane was 1.7 cm/s (95 % confidence interval 1.4–2.1 cm/s). Medians of S′ at T1, T2, and T3 (9.6, 8.9, and 7.5 cm/s, respectively) also exhibited significant declines (by 6.6, 15.6, and 21.2 % for T1 vs. T2, T2 vs. T3, and T1 vs. T3, p < 0.001, =0.002, and <0.001 in Friedman pairwise comparisons, respectively).

Conclusions

Administering sevoflurane as a part of a sevoflurane–remifentanil anesthesia regimen appears to dose-dependently reduce S′, indicating LV systolic performance, in patients undergoing cardiac surgery. Further studies may be required to evaluate the clinical implications of these findings.

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Acknowledgements

Konkuk University Medical Center, Konkuk University School of Medicine supported this study.

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Authors and Affiliations

  1. Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea

    Won-Kyoung Kwon, Woon-Seok Kang & Tae-Yop Kim

  2. Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea

    Tae-Yun Sung

  3. Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Korea

    Ga-Yon Yu

  4. Cardiothoracic Anesthesiology and Perfusion Unit, Sarawak General Hospital, Kuching, Malaysia

    Hanafi Sidik

  5. Department of Anesthesiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea

    Younsuk Lee

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  1. Won-Kyoung Kwon
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Correspondence to Tae-Yop Kim.

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Kwon, WK., Sung, TY., Yu, GY. et al. Effects of sevoflurane increments on left ventricular systolic long-axis performance during sevoflurane–remifentanil anesthesia for cardiovascular surgery. J Anesth 30, 223–231 (2016). https://doi.org/10.1007/s00540-015-2094-9

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  • DOI: https://doi.org/10.1007/s00540-015-2094-9

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