Why the study?
LV diastolic dysfunction increases perioperative morbidity and mortality, especially in elderly patients, and anesthetic agents may impair diastolic function.
Does remifentanil improve left ventricular diastolic parameters in elderly patients with preexisting diastolic dysfunction?
Does remifentanil improve left ventricular diastolic parameters in elderly patients with preexisting diastolic dysfunction?
Remifentanil at a target concentration of 2 ng/ml safely improves left ventricular diastolic parameters without impairing systolic function in elderly patients with preexisting diastolic dysfunction.
Answers are grounded in this paper and cite their sources.
May support remifentanil use in elderly patients with diastolic dysfunction; leaves open confirmation in randomized trials.
Background Left ventricular diastolic dysfunction has a significant impact on perioperative morbidity and mortality, and its incidence is high in elderly individuals. Anesthetic agents may impair diastolic function, which may increase the incidence of perioperative complications. The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle (LV) diastolic function in patients with diastolic dysfunction. The study was performed on 30 spontaneously breathing subjects (aged 60–80 years) with diastolic dysfunction. Methods Thirty patients (aged 60–80 years) with diastolic dysfunction scheduled for surgery were recruited between November 2019 and March 2023. Left ventricle function was evaluated once the intravenous remifentanil infusion reached a target-controlled concentration of 2 ng/ml with transthoracic echocardiography. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm), whereas diastolic function focused on changes in transmitral peak flow (E), E/A, mitral septal and lateral e’ waves, E/e’ ratios and left atrial volume index following remifentanil infusion. Results Diastolic function measures of LV (mitral E/e’, septal and lateral e’ waves) statistically significantly improved (E/e’ from 10.6 ± 2.9 cm.sn − 1 to 9.5 ± 2.2 cm.sn − 1 ; p = 0.006) following remifentanil infusion. Left atrial volume index decreased following remifentanil infusion without statistical significance (from 55 ± 14.4 ml.cm − 2 to 51.6 ± 13.3 ml.cm − 2 ; p = 0.1). Systolic function (ejection fraction and Sm) did not change following remifentanil infusion. Conclusions Remifentanil improves left ventricular diastolic parameters in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a plasma concentration of 2 ng.ml − 1 might be used safely in patients with left ventricular diastolic dysfunction.
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Köner et al. (2024) studied this question.
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