Key result
Sevoflurane at one MAC significantly decreased left atrial active emptying fraction from 32.2% to 18.0% compared to baseline in patients undergoing coronary artery bypass grafting.
Why the study?
Patients undergoing CABG frequently have left ventricular diastolic dysfunction and depend on left atrial contraction to generate cardiac output, but sevoflurane affects overall cardiac contractility.
Does sevoflurane at one MAC affect left atrial performance and left ventricular diastolic function in patients undergoing CABG?
Observational (n=31)
No
Does sevoflurane at one MAC affect left atrial performance and left ventricular diastolic function in patients undergoing CABG?
Sevoflurane at 1 MAC significantly impairs left atrial active contractility and slightly reduces left ventricular ejection fraction in patients undergoing CABG, suggesting it may not be ideal for patients relying on atrial kick for ventricular filling.
Sevoflurane may impair left atrial contractility in CABG; hypothesis-generating for anesthetic selection in atrial-dependent filling.
Background Patients presenting for coronary artery bypass grafting often have left ventricular diastolic dysfunction. These patients are in need for a well contracting left atrium (LA) to generate the required cardiac output. Sevoflurane affects the overall cardiac contractility. This study aimed at evaluating sevoflurane effects on left atrial performance and left ventricular diastolic function for patients undergoing coronary artery bypass graft (CABG) using transesophageal echocardiography (TEE). Results Out of 40 enrolled patients, analysis was made for 31 patients. Results after exposure to one MAC sevoflurane revealed a decrease of left atrial functional area change (P = 0.001), left atrial active emptying fraction (P = 0.038), and A wave velocity by transmitral pulsed wave Doppler (P = 0.019) while left ventricular diastolic function was unaffected despite a significant decrease in left ventricular ejection fraction (P = 0.008). Conclusions Sevoflurane at one MAC affected the left atrial performance without affecting left ventricular diastolic function in patients with grade I and II diastolic dysfunction undergoing CABG. Trial registration NCT03999463.
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Hasseb et al. (2023) conducted an observational in Coronary artery disease undergoing CABG (n=31). Sevoflurane vs. Baseline (propofol anesthesia) was evaluated on Mean left atrial active emptying fraction (LA-AEF) change (MD 14.1, 95% CI 0.8-27.5, p=0.038). Sevoflurane at one MAC significantly decreased left atrial active emptying fraction from 32.2% to 18.0% compared to baseline in patients undergoing coronary artery bypass grafting.
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