Influence of Anesthetics on Cardiac Index and Metabolic Outcomes in Mitral and Aortic Valve Replacement in Adults: A Randomized Clinical Study.
Anesth Pain Med 2023;
13:e134119. [PMID:
37601959 PMCID:
PMC10439691 DOI:
10.5812/aapm-134119]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 08/22/2023] Open
Abstract
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.
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