Sevoflurane's Effect on Mitral Valve Annular Velocity in Cardiac Surgery

Study Overview
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Brief Summary
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The purpose of this study is to determine sevoflurane's dose-dependent effect on left ventricular (LV) function in cardiac surgery. The change of tissue Doppler imaging (TDI) of lateral mitral valve annular velocity at three different sevoflurane concentrations would be analyzed by using intraoperative transesophageal echocardiography (TEE)in cardiac surgery patients.

Detailed Description
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Following data would be determined after 10 min-exposure to each dosage of sevoflurane with 1.0, 2.0 and 3.0 inspired vol% (T1, T2 and T3, respectively) during remifentanil-based anesthesia (1.0 mcg/kg/min) for cardiac surgery (n=14): TDI of lateral mitral annulus at systole (S'), early filling (E') and atrial contraction (A') transmitral flow Doppler at early filling (E), atrial contraction (A), deceleration time; LV-ejection fraction (EF) bispectral index (BIS) phenylephrine-infusion rate other pressure derived hemodynamic parameters:heart rate; systolic, diastolic, and mean blood pressures; systolic, diastolic, and mean pulmonary artery pressures; central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), mixed venous O2 saturation (SvO2), cardiac index (CI) and stroke volume index (SVI)

Official Title
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Sevoflurane's Effect on Tissue Doppler Profiles of Lateral Mitral Annulus During Cardiac Surgery

Conditions
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Valvular Heart Disease

Intervention / Treatment
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* Drug: Sevoflurane dosage titration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients undergoing cardiac surgery Exclusion Criteria: low ejection fraction < 50% in preoperative transthoracic echocardiography atrial fibrillation pacemaker pericardial and infiltrative myocardial disease mitral annular calcification, surgical rings, prosthetic mitral valves lateral left ventricular regional wall motion abnormality esophageal spasm,stricture, laceration, perforation, and diverticulum diaphragmatic hernia, history of extensive radiation to the mediastinum upper gastrointestinal bleeding

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: sevoflurane<br>10 min exposure to sevoflurane 1.0, 2.0 and 3.0 inspiratory vol% at sevoflurane dosage titration | Drug: Sevoflurane dosage titration<br>* comparisons of the effect of the 10 min-inhalation of each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3)<br>* Other names: sevorane;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peak mitral annular velocity during systole (S') | By using pulsed Doppler with the sample volume positioned at the lateral MV ring in the midesophageal 4-chamber view, S' would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane 1.0 vol%, 2.0 vol% and 3.0 vol% | 
| Peak mitral annular velocity during early filling (E') | By using pulsed Doppler with the sample volume positioned at the lateral MV ring in the midesophageal 4-chamber view, E' would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane of 1.0 vol%, 2.0 vol% and 3.0 vol% | 
| peak mitral annular velocity during atrial contraction(A') | By using pulsed Doppler with the sample volume positioned at the lateral MV ring in the midesophageal 4-chamber view, A' would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane 1.0 vol%, 2.0 vol% and 3.0 vol% | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ejection fraction (EF) | By using modified Simpson technique in the midesophageal 4-chamber view, EF would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflrane 1.0vol%, 2.0 vol% and 3.0 vol% | 
| bispectral index (BIS) | BIS would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane 1.0 vol%, 2.0 vol% and 3.0 vol% | 
| peak velocity of mitral inflow during early relaxation (E) | By using pulsed Doppler with the sample volume positioned at the lMV opening in the midesophageal 4-chamber view, S' would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane 1.0 vol%, 2.0 vol% and 3.0 vol% | 
| peak velocity of mitral inflow during atrial contraction (A) | By using pulsed Doppler with the sample volume positioned at the tip of MV oeneing in the midesophageal 4-chamber view, A would be determined just after the 10 min-exposure to each concentration of sevoflurane, 1.0 inspired vol%, 2.0 inspired vol% and 3.0 inspired vol% (T1, T2 and T3, respectively) | after 10 min exposure to sevoflurane 1.0 vol%, 2.0 vol% and 3.0 vol% | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cardiac surgery, sevoflurane, tissue Doppler