title: Effects of sevoflurane increments on left ventricular systolic long-axis performance during sevoflurane-remifentanil anesthesia for cardiovascular surgery.
abstract: BACKGROUND
  The direct impact of sevoflurane on intraoperative left ventricular (LV) systolic performance during cardiac surgery has not been fully elucidated. Peak systolic tissue Doppler velocities of the lateral mitral annulus (S') have been used to evaluate LV systolic long-axis performance. We hypothesized that incremental sevoflurane concentration (1.0-3.0 inspired-vol%) would dose-dependently reduce S' in patients undergoing cardiac surgery due to mitral or aortic insufficiency.
  
  
  METHODS
  In 20 patients undergoing cardiac surgery in sevoflurane-remifentanil anesthesia, we analyzed intraoperative S' values which were determined after 10 min exposure to sevoflurane at 1.0, 2.0, and 3.0 inspired-vol% (T1, T2, and T3, respectively) with a fixed remifentanil dose (1.0 μg/kg/min) using transesophageal echocardiography.
  
  
  RESULTS
  Linear mixed-effect modeling demonstrated dose-dependent declines in S' according to the end-tidal sevoflurane concentration increments (C(ET)-sevoflurane, p < 0.001): the mean value of S' reduction for each 1.0 vol%-increment of C(ET)-sevoflurane was 1.7 cm/s (95 % confidence interval 1.4-2.1 cm/s). Medians of S' at T1, T2, and T3 (9.6, 8.9, and 7.5 cm/s, respectively) also exhibited significant declines (by 6.6, 15.6, and 21.2 % for T1 vs. T2, T2 vs. T3, and T1 vs. T3, p < 0.001, =0.002, and <0.001 in Friedman pairwise comparisons, respectively).
  
  
  CONCLUSIONS
  Administering sevoflurane as a part of a sevoflurane-remifentanil anesthesia regimen appears to dose-dependently reduce S', indicating LV systolic performance, in patients undergoing cardiac surgery. Further studies may be required to evaluate the clinical implications of these findings.
authors.affiliation: Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea.
authors.forename: Won-Kyoung
authors.initials: WK
authors.lastname: Kwon
authors.affiliation: Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Tae-Yun
authors.initials: TY
authors.lastname: Sung
authors.affiliation: Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Ga-Yon
authors.initials: GY
authors.lastname: Yu
authors.affiliation: Cardiothoracic Anesthesiology and Perfusion Unit, Sarawak General Hospital, Kuching, Malaysia.
authors.forename: Hanafi
authors.initials: H
authors.lastname: Sidik
authors.affiliation: Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea.
authors.forename: Woon-Seok
authors.initials: WS
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
authors.forename: Younsuk
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea. taeyop@gmail.com.
authors.forename: Tae-Yop
authors.initials: TY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D013599:Systole
chemical_list: D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil
keywords: Cardiac surgery; Sevoflurane; Systolic function; Tissue Doppler imaging; Transesophageal echocardiography