Sevoflurane and Desflurane, using TEE, on Diastolic Dysfunction of Patients Undergoing CABG

What is it about?

Sevoflurane and Desflurane, using TEE, on Diastolic Dysfunction of Patients Undergoing CABG

Featured Image

Photo by National Cancer Institute on Unsplash

Photo by National Cancer Institute on Unsplash

Why is it important?

Introduction: Diastolic dysfunction is a cause of morbidity and mortality in patients of coronary artery with normal systolic function. Diastolic dysfunction is highly predictive of adverse events after myocardial infarction. Transesophageal Echocardiography (TEE) is a non­invasive tool to investigate and diagnose perioperative diastolic dysfunction, which may influence the anesthetic management and post­operative outcome. This study was designed to compare the effects of Isoflurane Sevoflurane and desflurane on left ventricular diastolic dysfunction, using TEE in patients posted for CABG. Materials and Methods: 90 consenting adult patients, below the age of 70 years with grade 1 diastolic dysfunction posted for elective CABG surgery were included in this randomized cross sectional observational study and randomly divided in 3 groups of 30 patients each using a sealed envelope method. Group I received isoflurane, group S received sevoflurane & group D, desflurane. Ventricular relaxation criteria measured by the TEE were E (early diastolic peak velocity across the mitral valve), A (late diastolic peak velocity across the mitral valve), E/A ratio, S/D ratio, deceleration time (DT), e’ (early mitral annular velocity), E/e’ ratio. Parameters measured by the PA catheter were pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), pulmonary vascular resistance (PVR). Other hemodynamic parameters recorded were mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), oxygen saturation (SpO2). Statistical analysis and Results: Descriptive statistics like mean, median and proportions were used to describe the study results. Binary or ordinal data were expressed as number (%) and continuous numeric variables were expressed as Mean±SD. Qualitivedata was analyzed by Pearsons chi square test. Analysis of variance was done for repeated measure of continuous variables by one way ANOVA. A p value of < 0.05 was considered as statistically significant. Significant improvement was seen in all the left ventricular relaxation indices as measured by TEE after using the three inhalational agents in the study. Conclusion: Our study establishes the safety of all the three inhalational agents which are currently used in cardiac anesthesia. The pre­existing grade 1 diastolic dysfunction in patients remained the same. It is recommended to study this with larger sample size.

Perspectives