Different effects of sevoflurane, desflurane, and isoflurane on early and late left ventricular diastolic function in young healthy adults

作者：Bolliger D^*; Seeberger M D; Kasper J; Bernheim A; Schumann R M; Skarvan K; Buser P; Filipovic M

来源：British Journal of Anaesthesia, 2010, 104(5): 547-554.

DOI：10.1093/bja/aeq066

• anaesthetics volatile
• desflurane
• anaesthetics volatile
• isoflurane
• anaesthetics volatile
• sevoflurane
• heart
• myocardial function
• monitoring
• echocardiography

Knowledge on the effects of volatile anaesthetics on left ventricular (LV) diastolic function in humans in vivo is limited. We tested the hypothesis that sevoflurane, desflurane, and isoflurane do not impair LV diastolic function in young healthy humans.
Sixty otherwise healthy subjects (aged 18-48 yr) undergoing minor procedures under general anaesthesia were studied. After randomization for the anaesthetic, transthoracic echocardiographic examinations were performed at baseline and under anaesthesia with 1 minimum alveolar concentration (MAC) of the volatile anaesthetics during spontaneous breathing and intermittent positive pressure ventilation (IPPV). Peak early (E') and late (A') diastolic velocities of the mitral annulus were studied as the main echocardiographic indicators of diastolic function.
During anaesthesia with 1 MAC under spontaneous breathing, E' increased with desflurane (P < 0.001), was not significantly different with isoflurane (P=0.030), and decreased with sevoflurane (P=0.006). During IPPV, E' was similar to baseline with desflurane (P=0.550), insignificantly decreased with isoflurane (P=0.029), and decreased with the sevoflurane group (P < 0.001). In contrast, A' was similarly reduced in all groups during spontaneous breathing without further changes during IPPV. Haemodynamic changes were comparable in all study groups.
The findings of this in vivo study indicate that desflurane and isoflurane, and most likely sevoflurane, have no relevant direct negative effect on early diastolic relaxation in young healthy humans. In contrast, all three volatile anaesthetics appear to impair late diastolic LV filling during atrial contraction.
Trial Registration #: NCT0024451.

• 出版日期2010-5