title: Volatile anaesthetics and positive pressure ventilation reduce left atrial performance: a transthoracic echocardiographic study in young healthy adults.
abstract: BACKGROUND
  Animal and in vitro studies suggest that volatile anaesthetics affect left atrial (LA) performance. We hypothesized that human LA pump function and dimensions are altered by volatile anaesthetics in vivo.
  
  
  METHODS
  We performed transthoracic echocardiographic (TTE) measurements in 59 healthy subjects (aged 18-48 yr) undergoing minor surgery under general anaesthesia. The unpremedicated patients were randomly assigned to anaesthesia with sevoflurane, desflurane, or isoflurane. TTE examinations were performed at baseline and after induction of anaesthesia and upon placement of a laryngeal mask during spontaneous breathing. After changing to intermittent positive pressure ventilation (IPPV), an additional TTE was performed. The study focused on the velocity-time integral of late peak transmitral inflow velocity (AVTI) and maximum LA volume.
  
  
  RESULTS
  We found no evidence for relevant differences in the effects of the three volatile anaesthetics. AVTI decreased significantly from 4.1 (1.2) cm at baseline to 3.2 (1.1) cm during spontaneous breathing of 1 minimum alveolar concentration of volatile anaesthetics. AVTI decreased further to 2.8 (1.0) cm after changing to IPPV. The maximum LA volume was 45.4 (18.6) cm(3) at baseline and remained unchanged during spontaneous breathing but decreased to 34.5 (16.7) cm(3) during IPPV. Other parameters of LA pump function and dimensions decreased similarly.
  
  
  CONCLUSIONS
  Volatile anaesthetics reduced active LA pump function in humans in vivo. Addition of IPPV decreased LA dimensions and further reduced LA pump function. Effects in vivo were less pronounced than previously found in in vitro and animal studies. Further studies are warranted to evaluate the clinical implications of these findings.
  
  
  BACKGROUND
  NCT0024451.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, CH-4031 Basel, Switzerland david.freiermuth@gmx.net.
authors.forename: D
authors.initials: D
authors.lastname: Freiermuth
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Skarvan
authors.affiliation: Institute for Anaesthesia, Cantonal Hospital St Gallen, CH-9007 St Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Filipovic
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: M D
authors.initials: MD
authors.lastname: Seeberger
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Bolliger
mesh_terms: D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000077335:Desflurane; D005260:Female; D064368:Healthy Volunteers; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D012016:Reference Values; D000077149:Sevoflurane; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane
keywords: anaesthetic effects; echocardiography, transthoracic; inhalation anaesthetics; left atrial function