The purpose of this study is to determine Isoflurane's dose-dependent effect on left ventricular (LV) systolic function in cardiac surgery. The change of tissue Doppler imaging (TDI) of lateral mitral valve annular systolic velocity at three different isoflurane concentrations would be analyzed by using intraoperative transesophageal echocardiography (TEE) in cardiac surgery patients.
Isoflurane is widely used in cardiac surgery patients due to its beneficial effects, but many studies have shown that isoflurane reduces myocardial contractility in a dose-dependent manner, and compromises left ventricular (LV) function. Tissue Doppler imaging (TDI) of mitral annular velocity during the cardiac cycle has been introduced as a reliable method for analysis of systolic and diastolic LV long-axis function. Efficacy of systolic and diastolic TDI profiles, including systole (S'), early early relaxation (E')and atrial contraction (A') have been suggested to be useful in predicting the impact of isoflurane on LV systolic and diastolic function. The investigators hypothesized that isoflurane, even at a clinical dosage, would affects intraoperative LV systolic function in a dose-dependent manner and thus produce significant changes int the TDI profiles of systolic mitral annular velocity (S'). So the investigators planned to study the changes in S' of lateral mitral annulus at the clinical isoflurane dosage during remifentanil based anesthesia for cardiac surgery.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
20
10 min-inhalation of each concentration of isoflurane, 1.0 MAC
10 min-inhalation of each concentration of isoflurane, 1.5 MAC
10 min-inhalation of each concentration of isoflurane, 2.0 MAC
Konkuk University Medical Center
Seoul, Seoul, South Korea
Peak mitral annular velocity during systole(S')
By using pulsed Doppler with the sample volume positioned at the lateral mitral valve (MV)ring in the midesophageal 4-chamber view, S' would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC (T1, T2 and T3, respectively)
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
ejection fraction(EF)
By using modified Simpson technique in the midesophageal 4-chamber view, EF would be determined just after the 10 min-exposure to each concentration of isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
bispectral index(BIS)
BIS would be determined just after the 10 min-exposure to each concentration of isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
peak velocity of mitral inflow during early relaxation(E)
By using pulsed Doppler with the sample volume positioned at the IMV opening in the midesophageal 4-chamber view, E' would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC(T1, T2 and T3, respectively)
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
peak velocity of mitral inflow during atrial contraction(A)
By using pulsed Doppler with the sample volume positioned at the tip of MV opening in the midesophageal 4-chamber view, "A" would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC(T1, T2 and T3, respectively)
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
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Peak mitral annular velocity during early diastole(E')
By using pulsed Doppler with the sample volume positioned at the lateral MV ring
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC
Peak mitral annular velocity during atrial contraction(A')
By using pulsed Doppler with the sample volume positioned at the lateral MV ring
Time frame: after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC