The effect of depth of anesthesia on the severity of mitral regurgitation as measured by transesophageal echocardiography.
OBJECTIVE
The unloading effect of anesthesia on the left ventricle results in a downgrade of mitral regurgitation (MR) severity, which increases as anesthesia deepens. This study examined how the depth of anesthesia could affect the loading condition of the left ventricle and the severity of MR.


METHODS
A prospective study.


METHODS
Cardiac operating room at a single institution.


METHODS
Twenty patients with functional MR and 20 patients with organic MR.


METHODS
Different anesthetic depths determined by bispectral index (BIS) monitoring.


RESULTS
In patients with functional MR, maximal regurgitant jet area (JA), the vena contracta (VC) width, and the proximal isovelocity surface area (PISA) radius were significantly smaller at a low BIS than at a high BIS (JA, 2.4 cm(2), 1.9-4.7, v 5.0 cm(2), 3.4-6.7, p < 0.001; VC width, 2.7 ± 1.6 v 4.2 ± 1.4 mm, p < 0.001; PISA radius, 3.3 ± 2.3 v 5.6 ± 2.4 mm, p < 0.001). Similarly, in patients with organic MR, JA, VC width, and PISA radius were significantly smaller at a low BIS than at a high BIS (JA, 7.0 ± 2.4 v 9.7 ± 3.6 cm(2), p = 0.002; VC width, 5.7 mm, 4.1-6.6, v 7.1 mm, 5.4-8.4, p < 0.001; PISA radius, 9.0 ± 2.8 v 12.0 ± 3.3 mm, p < 0.001).


CONCLUSIONS
It may be helpful to measure the severity of MR at a shallower anesthesia depth guided by BIS monitoring to avoid a downgrade of MR under general anesthesia.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ji-Hyun
JH
Chin
Eun-Ho
EH
Lee
Dae-Kee
DK
Choi
In-Cheol
IC
Choi
D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome