Abstract
Purpose
To determine the effect of isoflurane on left ventricular diastolic function, as assessed by Doppler echocardiography.
Methods
Ten patients with normal cardiovascular function were enrolled. Doppler measurements of mitral inflow velocities, and pulmonary venous blood flow velocities were measured preoperatively (transthoracic echocardiography), and intraoperatively (transesophageal echocardiography) at isoflurane MAC 1 and MAC 1.5. Heart rate and blood pressure were measured concomitantly. Variables were compared with repeated measures ANOVA.
Results
Isoflurane at both doses caused equal decreases in mitral inflow A(atrial systole) velocity (control: 43±12.3 cm.sec−1 vs MAC 1: 31 ±6.0 cm·sec−1 and MAC 1.5: 31.3 ± 7.9 cm · sec−1 P < 0.01), the deceleration time of the mitral inflow E (early) velocity (control: 178 ± 31.7 msec versus MAC 1: 127 ± 38.3 msec and MAC 1.5: 137 ± 28.4 msec, P < 0.01), and mean blood pressure (control: 91.1 ± 15.4 mmHg versus MAC 1: 76.1 ± 8.8 mmHg and MAC 1.5: 71.9 ± 6.2 mmHg, P < 0.002). Isoflurane at both doses caused an equal increase in the E/A ratio (control: 1.5 ± 0.57 vs MAC 1: 2.0 ± 0.6 and MAC 1.5: 2.2 ± 0.78, P < 0.01). No changes in mitral inflow E or pulmonary venous velocities were seen.
Conclusion
The changes in Doppler velocities of mitral inflow and pulmonary venous flow with isoflurane are not consistent with prolonged left ventricular relaxation nor increased myocardial restriction, but are more likely the result of alterations in left ventricular loading conditions and atrial systolic function.
Résumé
Objectif
Préciser l’effet de l’isoflurane sur la fonction diastolique ventriculaire gauche à l’aide de l’échocardiographie Döppler.
Méthodes
Dix patients dont la fonction cardiovasculaire gauche était normale ont été choisis pour cette étude. Des mesures par Döppler de la vélocité de l’afflux sanguin mitral et de la vélocité du débit veineux pulmonaire ont été déterminées avant l’intervention (échographie transthoracique) et pendant l’intervention (échographie transoesophagienne) à MAC 1 et 1,5 d’isoflurane. Les variables ont été comparées par des mesures ANOVA répètes.
Résultats
Aux deux concentrations, l’isoflurane a provoqué des baisses égales de la vélocité de l’afflux mitral A (systole auriculaire) (contrôle: 43 ± 12,3 cm·sec−1 vs MAC 1: 31 ± 6,0 cm · sec−1 et MAC 1,5: 31,3 ± 7,9 cm · sec−1, P < 0,01), du temps de décélération de l’afflux mitral E (précoce) (contrôle: 178 ± 31,7 msec vs MAC 1: 127 ± 38,3 msec et MAC 1,5 et MAC 1,5; 137 ± 28,4 msec, P < 0,01) et de la pression artérielle moyenne (contrôle: 91,1 ± 15,4 mmHg vs MAC 1: 76,1 ± 8,8 mmHg et MAC 1,5: 71,9 ± 6,2 mmHg, P < 0,002). Aux deux concentrations, l’isoflurance a provoqué une augmentation égale du rapport E/A (contrôle: 1,5 ± 0.57 vs MAC 1,5: 2,0 ± 0,6 et MAC 1,5: 2,2 ± 0,78, P < 0,01). La vélocité de l’afflux mitral E et celle du débit veineux pulmonaire n ’ont pas changé.
Conclusion
Au Döppler, les changements de la vélocité de l’afflux mitral et du débit veineux pulmonaire dus à l’isoflurane ne correspondent ni à une relaxation prolongée du ventricule gauche ni à une augmentation de la restriction myocardique, mais sont vraisemblablement le résultat d’altérations des conditions de charge du ventricule gauche et de la fonction systolique auriculaire.
Article PDF
Similar content being viewed by others
References
Nishimura RA, Housmans PR, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part I. Physiologic and pathophysiologic features. Mayo Clin Proc 1989; 64: 71–81.
Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc 1989; 64: 181–204.
Pagel PS, Kampine JP, Schmeling WT, Warltier DC. Alteration of left ventricular diastolic function by desflurane, isoflurane, and halothane in the chronically instrumented dog with autonomic nervous system blockade. Ancsthesiology 1991; 74: 1103–14.
Harkin CP, Pagel PS, Kersten JR, Hettrick DA, Warltier DC. Direct negative inotropic and lusitropic effects of sevoflurane. Anesthesiology 1994; 81: 156–67.
Pagel PS, Schmeling WT, Kampine JP, Warltier DC. Alteration of canine left ventricular diastolic function by intravenous anestheticsin vivo. Anesthesiology 1992; 76: 419–25.
Yamada T, Takeda J, Koyama K, Sekiguchi H, Fukushima K, Kawazoe T. Effects of sevoflurane, isoflurane, enflurane, and halothane on left ventricular diastolic performance in dogs. J Cardiothorac Vase Anesth 1994; 8: 618–24.
Yellin EL, Nikolic S, Frater RWM. Left ventricular filling dynamics and diastolic function. Prog Cardiovasc Dis 1990; 32: 247–71.
Mirsky I, Pasipoularides A. Clinical assessment of diastolic function. Prog Cardiovasc Dis 1990; 32: 291–318.
Nishimura RA, Abel MD, Housmans PR, Warnes CA, Tajik AJ. Mitral flow velocity curves as a function of different loading conditions: evaluation by intraoperative transesophageal Doppler echocardiography. J Am Soc Echocardiogr 1989; 2: 79–87.
Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation 1985; 71: 543–50.
Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Circulation 1990; 81: 1488–97.
Starling MR, Montgomery DG, Mancini J, Walsh RA. Load independence of the rate of isovolumic relaxation in man. Circulation 1987; 76: 1274–81.
Benjamin EJ, Levy D, Anderson KM, et al. Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham heart study). Am J Cardiol 1992; 70: 508–15.
Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc 1994; 69: 212–24.
Klein AL, Tajik AJ. Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease. J Am Soc Echocardiogr 1991; 4: 379–92.
Thomas JD, Weyman AE. Echocardiographic Doppler evaluation of left ventricular diastolic function. Physics and physiology. Circulation 1991; 83: 977–90.
Kuecherer HF, Muhiudeen IA, Kusumoto FM, el al. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 1990; 82: 1127–39.
Pagel PS, Grossman W, Haering JM, Warltier DC. Left ventricular function in the normal and diseased heart. Perspectives for the anesthesiologist (first of two parts). Anesthesiology 1993; 79: 836–54.
Pagel PS, Grossman W, Haering JM, Warltier DC. Left ventricular diastolic function in the normal and diseased heart. Perspectives for the anesthesiologist (second of two parts). Anesthesiology 1993; 79: 1104–20.
Pombo JF, Troy BL, Russell RD Jr. Left ventricular volumes and ejection fraction by echocardiography. Circulation 1971; 43: 480–90.
Ihara T, Shannon RP, Komamura K, et al. Effects of anaesthesia and recent surgery on diastolic function. Cardiovasc Res 1994; 28: 325–36.
Houltz E, Ricksten S-E, Milocco I, Gustavsson T, Caidahl K. Effects of adenosine infusion on systolic and diastolic left ventricular function after coronary artery bypass surgery: evaluation by computer-assisted quantitative 2-D and Doppler echocardiography. Anesth Analg 1995; 80: 47–53.
Goertz AW, Lindner KH, Schültz W, Schirmer U, Beyer M, Georgieff M. Influence of phenylephrine bolus administration on left ventricular filling dynamics in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology 1994; 81: 49–58.
Pagel PS, Kampine JP, Schmeling WT, Warltier DC. Reversal of volatile anesthetic-induced depression of myocardial contractility by extracellular calcium also enhances left ventricular diastolic function. Anesthesiology 1993; 78: 141–54.
Kleinman JP, Czer LSC, DeRobertis M, Chaux A, Maurer G. A quantitative comparison of transesophageal and epicardial color Doppler echocardiography in the intraoperative assessment of mitral regurgitation. Am J Cardiol 1989; 64: 1168–72.
Castello R, Pearson AC, Lenzen P, Labovitz AJ. Evaluation of pulmonary venous flow by transesophageal echocardiography in subjects with a normal heart: comparison with transthoracic echocardiography. J Am Coll Cardiol 1991; 18: 65–71.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oxorn, D., Edelist, G., Harrington, E. et al. Echocardiographic assessment of left ventricular filling during isoflurane anaesthesia. Can J Anaesth 43, 569–574 (1996). https://doi.org/10.1007/BF03011768
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011768