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Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?

Background: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to cont...

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Published in:Acta anaesthesiologica Scandinavica 1999-08, Vol.43 (7), p.737-743
Main Authors: Eyraud, D., Benmalek, F., Teugels, K., Bertrand, M., Mouren, S., Coriat, P.
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container_title Acta anaesthesiologica Scandinavica
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Benmalek, F.
Teugels, K.
Bertrand, M.
Mouren, S.
Coriat, P.
description Background: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension. Methods: In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 μg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (t0)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 3 l/min. Results: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end‐systolic wall‐stress (ESWS) and left‐ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post‐induction values with mean end‐tidal concentration of 5.1±0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end‐diastolic and end‐systolic cross‐sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. Conclusion: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.
doi_str_mv 10.1034/j.1399-6576.1999.430709.x
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The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension. Methods: In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 μg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (t0)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 3 l/min. Results: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end‐systolic wall‐stress (ESWS) and left‐ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post‐induction values with mean end‐tidal concentration of 5.1±0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end‐diastolic and end‐systolic cross‐sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. Conclusion: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1034/j.1399-6576.1999.430709.x</identifier><identifier>PMID: 10456814</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Copenhagen: Munksgaard International Publishers</publisher><subject><![CDATA[anesthesia ; Anesthetics, Inhalation - administration & dosage ; Anesthetics, Intravenous - administration & dosage ; Anesthetics. Neuromuscular blocking agents ; Aorta - surgery ; Atracurium - administration & dosage ; Biological and medical sciences ; Blood Pressure - physiology ; Cardiac Output - drug effects ; Catheterization, Swan-Ganz ; Desflurane ; Diastole ; Echocardiography, Transesophageal ; Female ; Heart Rate - drug effects ; Heart Ventricles - drug effects ; Humans ; Hypertension - prevention & control ; Intraoperative Complications - prevention & control ; Intraoperative hypertension ; Intubation, Intratracheal ; Isoflurane - administration & dosage ; Isoflurane - analogs & derivatives ; Male ; Medical sciences ; Midazolam - administration & dosage ; Middle Aged ; Neuromuscular Nondepolarizing Agents - administration & dosage ; Neuropharmacology ; Nitrous Oxide - administration & dosage ; Oxygen - administration & dosage ; Pharmacology. Drug treatments ; Stroke Volume - drug effects ; Sufentanil - administration & dosage ; Systole ; transesophageal echocardiography ; Vascular Resistance - drug effects ; ventricular function ; Ventricular Function, Left - drug effects]]></subject><ispartof>Acta anaesthesiologica Scandinavica, 1999-08, Vol.43 (7), p.737-743</ispartof><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4379-d0e3e0278256ebfc8cbfa5865dd779f82c520243d49f113b60145d937564b2b23</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1882444$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10456814$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eyraud, D.</creatorcontrib><creatorcontrib>Benmalek, F.</creatorcontrib><creatorcontrib>Teugels, K.</creatorcontrib><creatorcontrib>Bertrand, M.</creatorcontrib><creatorcontrib>Mouren, S.</creatorcontrib><creatorcontrib>Coriat, P.</creatorcontrib><title>Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. 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Results: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end‐systolic wall‐stress (ESWS) and left‐ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post‐induction values with mean end‐tidal concentration of 5.1±0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end‐diastolic and end‐systolic cross‐sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. Conclusion: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.</description><subject>anesthesia</subject><subject>Anesthetics, Inhalation - administration &amp; dosage</subject><subject>Anesthetics, Intravenous - administration &amp; dosage</subject><subject>Anesthetics. 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Drug treatments</subject><subject>Stroke Volume - drug effects</subject><subject>Sufentanil - administration &amp; dosage</subject><subject>Systole</subject><subject>transesophageal echocardiography</subject><subject>Vascular Resistance - drug effects</subject><subject>ventricular function</subject><subject>Ventricular Function, Left - drug effects</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><recordid>eNqNkE1v1DAQhi0EotvCX0BGQtwS7NiO4xOs-gXtAhIf4mg5zrh4ySaLnbS7_x6nWRWOnDzWPPPa8yD0kpKcEsbfrHPKlMpKIcucKqVyzogkKt89QouHzmO0IITQTFBZHKHjGNfpyrhST9ERJVyUFeULtD3rIeIGomvHYDrAph0g4BbcgG-hG4K3Y2sCdmNnB993-O4ndHiM0OChx7ZPRN_iOIYbb00qBr9J_D3ZjMF3N9j0YfD2HoGwf_sMPXGmjfD8cJ6g7xfn307fZ6vPlx9Ol6vMciZV1hBgQApZFaKE2tnK1s6IqhRNI6VyVWFFQQrOGq4cpawuCeWiUUyKktdFXbAT9HrO3Yb-9whx0BsfLbRtWrIfoy6VkkIQkUA1gzb0MQZwehv8xoS9pkRPuvVaT1L1JFVPuvWsW-_S7IvDI2O9geafydlvAl4dABOTH5cUWx__clVVcD5h72bszrew__8P6OXy61yniGyO8HGA3UOECb90KZMW_ePTpWZXH1dfrquVvmB_AMFHrPo</recordid><startdate>199908</startdate><enddate>199908</enddate><creator>Eyraud, D.</creator><creator>Benmalek, F.</creator><creator>Teugels, K.</creator><creator>Bertrand, M.</creator><creator>Mouren, S.</creator><creator>Coriat, P.</creator><general>Munksgaard International Publishers</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199908</creationdate><title>Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?</title><author>Eyraud, D. ; Benmalek, F. ; Teugels, K. ; Bertrand, M. ; Mouren, S. ; Coriat, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4379-d0e3e0278256ebfc8cbfa5865dd779f82c520243d49f113b60145d937564b2b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>anesthesia</topic><topic>Anesthetics, Inhalation - administration &amp; dosage</topic><topic>Anesthetics, Intravenous - administration &amp; dosage</topic><topic>Anesthetics. Neuromuscular blocking agents</topic><topic>Aorta - surgery</topic><topic>Atracurium - administration &amp; dosage</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - physiology</topic><topic>Cardiac Output - drug effects</topic><topic>Catheterization, Swan-Ganz</topic><topic>Desflurane</topic><topic>Diastole</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Heart Rate - drug effects</topic><topic>Heart Ventricles - drug effects</topic><topic>Humans</topic><topic>Hypertension - prevention &amp; control</topic><topic>Intraoperative Complications - prevention &amp; control</topic><topic>Intraoperative hypertension</topic><topic>Intubation, Intratracheal</topic><topic>Isoflurane - administration &amp; dosage</topic><topic>Isoflurane - analogs &amp; derivatives</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Midazolam - administration &amp; dosage</topic><topic>Middle Aged</topic><topic>Neuromuscular Nondepolarizing Agents - administration &amp; dosage</topic><topic>Neuropharmacology</topic><topic>Nitrous Oxide - administration &amp; dosage</topic><topic>Oxygen - administration &amp; dosage</topic><topic>Pharmacology. Drug treatments</topic><topic>Stroke Volume - drug effects</topic><topic>Sufentanil - administration &amp; dosage</topic><topic>Systole</topic><topic>transesophageal echocardiography</topic><topic>Vascular Resistance - drug effects</topic><topic>ventricular function</topic><topic>Ventricular Function, Left - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eyraud, D.</creatorcontrib><creatorcontrib>Benmalek, F.</creatorcontrib><creatorcontrib>Teugels, K.</creatorcontrib><creatorcontrib>Bertrand, M.</creatorcontrib><creatorcontrib>Mouren, S.</creatorcontrib><creatorcontrib>Coriat, P.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eyraud, D.</au><au>Benmalek, F.</au><au>Teugels, K.</au><au>Bertrand, M.</au><au>Mouren, S.</au><au>Coriat, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>1999-08</date><risdate>1999</risdate><volume>43</volume><issue>7</issue><spage>737</spage><epage>743</epage><pages>737-743</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension. Methods: In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 μg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (t0)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 3 l/min. Results: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end‐systolic wall‐stress (ESWS) and left‐ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post‐induction values with mean end‐tidal concentration of 5.1±0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end‐diastolic and end‐systolic cross‐sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. Conclusion: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.</abstract><cop>Copenhagen</cop><pub>Munksgaard International Publishers</pub><pmid>10456814</pmid><doi>10.1034/j.1399-6576.1999.430709.x</doi><tpages>7</tpages></addata></record>
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ispartof Acta anaesthesiologica Scandinavica, 1999-08, Vol.43 (7), p.737-743
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subjects anesthesia
Anesthetics, Inhalation - administration & dosage
Anesthetics, Intravenous - administration & dosage
Anesthetics. Neuromuscular blocking agents
Aorta - surgery
Atracurium - administration & dosage
Biological and medical sciences
Blood Pressure - physiology
Cardiac Output - drug effects
Catheterization, Swan-Ganz
Desflurane
Diastole
Echocardiography, Transesophageal
Female
Heart Rate - drug effects
Heart Ventricles - drug effects
Humans
Hypertension - prevention & control
Intraoperative Complications - prevention & control
Intraoperative hypertension
Intubation, Intratracheal
Isoflurane - administration & dosage
Isoflurane - analogs & derivatives
Male
Medical sciences
Midazolam - administration & dosage
Middle Aged
Neuromuscular Nondepolarizing Agents - administration & dosage
Neuropharmacology
Nitrous Oxide - administration & dosage
Oxygen - administration & dosage
Pharmacology. Drug treatments
Stroke Volume - drug effects
Sufentanil - administration & dosage
Systole
transesophageal echocardiography
Vascular Resistance - drug effects
ventricular function
Ventricular Function, Left - drug effects
title Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?
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