BJA Advance Access originally published online on November 19, 2004
British Journal of Anaesthesia 2005 94(2):186-192; doi:10.1093/bja/aei028
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation
1 Department of Anaesthesia and 2 Medical Intensive Care Unit, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland
* Corresponding author: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. E-mail: miodrag.filipovic{at}public-health.oxford.ac.uk or mfilipovic{at}uhbs.ch
Background. There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease.
Methods. Sixty patients (aged 18–47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol. Echocardiography was performed at baseline and during spontaneous respiration at 1 minimum alveolar concentration (MAC) of the inhalational agents or propofol 4 µg ml–1 (step 1), and repeated during positive-pressure ventilation with 1 and 1.5 MAC of the inhalational agents or with propofol 4 and 6 µg ml–1 (steps 2A and 2B). Analysis of echocardiographic measurements focused on heart rate corrected isovolumic relaxation time (IVRTc) and early diastolic peak velocity of the lateral mitral annulus (Ea).
Results. IVRTc decreased from baseline to step 1 in the halothane group (82 [95% CI, 76–88] ms and 74 [95% CI, 68–80] ms respectively; P=0.02), remained stable in the sevoflurane group (78 [95% CI, 72–83] ms and 73 [95% CI, 67–81] ms; n.s.) and increased in the propofol group (80 [95% CI, 74–86] ms and 92 [95% CI, 84–102] ms; P=0.02). Ea decreased in the propofol group only (18.8 [95% CI, 16.5–19.9] cm s–1 and 16.0 [95% CI, 14.9–17.9] cm s–1; P=0.003). From step 2A to step 2B, IVRTc increased further in the propofol group (109 [95% CI, 99–121] ms and 119 [95% CI, 99–135] ms; P=0.04) but remained stable in the other two groups. Ea did not change from step 2A to step 2B.
Conclusions. Halothane and sevoflurane did not impair LV relaxation, whereas propofol caused a mild impairment. However, the impairment by propofol was of a magnitude that is unlikely to cause clinical diastolic dysfunction.
Presented in part at the 18th Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists, Prague, May 25–28, 2003, and published in abstract form in Eur J Anaesthesiol 2003; 20 (Suppl. 29): A-30.
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