Influence of Anesthetics on Clinical Outcome in Mitral and Aortic Valve Replacement in Adults
Condition: Mitral Valve Insufficiency; Aortic Valve Insufficiency
MeSH terms: Mitral Valve Insufficiency; Aortic Valve Insufficiency
Study type: Interventional
Phase: Phase 3

Summary: 
      Abstract Anaesthetic support for cardiac surgery significantly influences the course of the
      intraoperative period and the success of the postoperative period. Total intravenous
      anaesthesia and inhalation anaesthesia are the traditional methods of anaesthesia in cardiac
      surgery. However, there are few studies assessing the effectiveness of surgical aggression
      protection in cardiac surgery.

      Objectives: To study the effect of anesthetics on clinical outcome after mitral and aortic
      valve replacement in adults.

      Methods. The data of 75 patients operated in the Cardiosurgery Department of the Medical
      Center Hospital of the Presidential Administration of the Republic of Kazakhstan were
      included in the study. All patients underwent mitral, aortic valve replacement/plasty under
      cardiopulmonary bypass (CPB) conditions.

      All patients were divided into 3 groups according to the type of anaesthesia: the first (1)
      group patients anaesthetised with propofol (P), the second group with sevoflurane (S), and
      the last one is with isoflurane (I).

      To maintain anaesthesia in Group 1 propofol was used as anaesthetic in a dose of 6 mg/kg/h
      intravenously on perfusion. In Group 2 the anaesthetic used was sevoflurane in a dose of
      1.7-1.9 MAC. Group 3 used isoflurane in the dose of 1.1-1.2 MAC as anaesthetic. Statistical
      analysis was done by the method of single factor analysis of variance and Kruskal Wallis
      criterion.
    

Detailed description: 
      This study includes data from 90 patients operated in the Cardiosurgery Department of the
      Medical Center Hospital of the Presidential Administration of the Republic of Kazakhstan were
      included in the study. All patients underwent mitral, aortic valve replacement/plasty under
      cardiopulmonary bypass (CPB) conditions. This research work was conducted between 2020 and
      2022. To calculate the sample size, the investigators used the formula n=t2*D*N/confidence
      interval*N+t2*α, which will allow to identify the static significance of the study.

      All patients were divided into 3 groups according to the type of anaesthesia: the first (1)
      group patients anaesthetised with propofol (P), the second group with sevoflurane (S), and
      the last one is with isoflurane (I).

      The study was conducted in 5 stages:

        1. Initial haemodynamic parameters and oxygen transport function of the patient's blood
           before anaesthesia were determined;

        2. After tracheal intubation;

        3. Before the CPB;

        4. After the CPB;

        5. The post-operative period until the patient is transferred to the specialized
           department.

      Before induction into anaesthesia, haemodynamic monitoring was started on admission to the
      operating theatre using a Nihon Kohden monitor (Japan). The right radial artery was
      catheterised for invasive monitoring of systemic arterial pressure and arterial blood
      sampling, and a catheter was then inserted into the central jugular vein (under ultrasound
      machine control) and guided into the right atrium for mixed venous blood sampling.

      Cardiac stroke volume was determined by transthoracic echocardiography (CS=end diastolic
      volume - end systolic volume). Cardiac output (CO=CS x heart rate), cardiac index (CI=CO/body
      surface area) were determined. the investigators determined blood oxygen content using the
      formula CaO2 (arterial ABB) and CvO2 (central mixed venous ABB) = [(1.34 × Hb × SO2) + (PO2 ×
      0.031)] / 100. Arteriovenous difference = CaO2-CvO2. Oxygen delivery was determined using the
      formula (DO2 = CI* CaO2). Oxygen consumption (VO2 = Cardiac index (CI)*AVD or VO2 = CO ×
      (CaO2 - CvO2) ~ CO × Hb × 1.34 × (SaO2 - SvO2) / 100).

      In the second stage, after tracheal intubation, indirect calorimetry was used to determine
      VO2, energy expenditure during anaesthesia using a Spirometry device (Oxford, UK), which was
      connected to an endotracheal tube and continuously showed oxygen demand and energy
      expenditure. A transesophageal echocardiography sensor was used to determine cardiac output.
      Additionally, the cardiac output was determined by Fick's formula. The same tests (cardiac
      output, cardiac index, consumption, oxygen delivery, energy expenditure) were performed in
      the third and fourth stages of anaesthesia. In the last stage, the consumption of muscle
      relaxants and opioid analgesics was calculated to assess the pharmaco-efficiency of
      anaesthetics. The time of extubation and the time of transfer of the patient to the
      specialized department were determined.

      All patients continued antihypertensive medication both before and on the day of surgery to
      prevent the development of withdrawal syndrome and to reduce the risk of perioperative
      myocardial ischaemia.
    

Intervention name(s): Propofol; Isoflurane; Sevoflurane
Intervention type(s): Drug; Drug; Drug
Intervention description(s): To maintain anaesthesia in Group 1 P, propofol was used as an anaesthetic in a dose of 4-6 mg/kg/h intravenously on a perfusor.; Isoflurane was used as an anaesthetic in a dose of - 1.1-1.2 MAC; sevoflurane was used as an anaesthetic in a dose of - 1.7-1.9 MAC
Other intervention name(s): Anesthesia; Anesthesia; Anesthesia
Intervention MeSH terms: Anesthetics; Propofol; Sevoflurane; Isoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: clinical outcome; sevoflurane; isoflurane; propofol; Mitral Valve Insufficiency; Aortic Valve Insufficiency