Key result
Volatile anesthetics and propofol had practically no effect on cardiac index during uncomplicated valve replacement surgery, though propofol significantly reduced oxygen consumption and energy expenditure.
Why the study?
Cardiac index and metabolic response to surgery are important intraoperative indicators, but the effects of sevoflurane, isoflurane, and propofol on these parameters during adult aortic and mitral valve replacement required determination.
Does propofol compared to sevoflurane or isoflurane improve cardiac index and metabolic outcomes in adults undergoing mitral and aortic valve replacement?
RCT (n=75)
Randomly assigned
No
Does propofol compared to sevoflurane or isoflurane improve cardiac index and metabolic outcomes in adults undergoing mitral and aortic valve replacement?
In adults undergoing uncomplicated mitral and aortic valve replacement, propofol anesthesia reduces oxygen consumption and energy expenditure compared to volatile anesthetics without adversely affecting cardiac index.
Anesthetic effects on CI during valve surgery need confirmation in larger trials; leaves open optimal agent selection.
Background: Cardiac index (CI) and metabolic response to surgery are important indicators of the course of the intraoperative period. Objectives: This study aimed to determine the effect of sevoflurane, isoflurane, and propofol on CI and metabolic outcomes during aortic and mitral valve replacement in adults. Methods: In this single-center prospective randomized controlled clinical study, a total of 75 patients were randomly assigned into 3 groups according to the type of anesthesia: The propofol group (n = 25), the sevoflurane group (n = 25), and the isoflurane group (n = 25). Cardiac stroke volume (SV) was determined by intraesophageal echocardiography (SV = end-diastolic volume – end-systolic volume). Cardiac output (CO) and CI were calculated according to the formulas. Oxygen consumption during surgery = CI × arteriovenous difference. Indirect calorimetry was used to determine energy expenditure during anesthesia using a spirometry device. Results: The use of anesthetics did not change CI. Cardiac index decreased from 3 to 2.9 L/min/m2 in the propofol group, increased from 3.1 to 3.2 L/min/m2 in the sevoflurane group, and decreased from 2.9 to 2.7 L/min/m2 in the isoflurane group. Compared to inhaled anesthetics, propofol significantly reduced VO2 from 179.1 to 135.7 mL/min/m2. Propofol reduced energy expenditure from 1483.7 to 1333.5 kcal. Conclusions: Volatile anesthetics, propofol has practically no effect on CI in an uncomplicated surgery. Anesthesia with propofol is associated with lower VO2 and better oxygen delivery to tissues. Energy consumption during propofol anesthesia decreases.
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Baiterek et al. (2023) conducted an RCT in Mitral and aortic valve replacement (n=75). Propofol, Sevoflurane, Isoflurane vs. Active comparators (3-arm trial) was evaluated on Cardiac index (CI) (p=0.001). Volatile anesthetics and propofol had practically no effect on cardiac index during uncomplicated valve replacement surgery, though propofol significantly reduced oxygen consumption and energy expenditure.
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