Key result
Anesthesia induction and positive pressure ventilation significantly reduced longitudinal right ventricular function, including a 1.6 mm decrease in TAPSE, while preserving global right ventricular ejection fraction and stroke volume.
Why the study?
General anesthesia induction and positive pressure ventilation create a vulnerable phase, but the impact of positive intrathoracic pressure on cardiac performance remains controversial.
Does anesthesia induction with positive pressure ventilation alter right ventricular function in patients undergoing elective cardiac surgery?
Observational (n=53)
No
Does anesthesia induction with positive pressure ventilation alter right ventricular function in patients undergoing elective cardiac surgery?
Mean Difference: -1.6 (95% CI -2.6–-0.7)
Absolute Event Rate: 16% vs 18%
p-value: p=0.0013
Anesthesia induction with positive pressure ventilation reduces baso-apical right ventricular function but preserves global right ventricular ejection fraction and stroke volume.
RV longitudinal indices decline post-induction while RVEF and stroke volume stay preserved; leaves open clinical relevance in cardiac patients.
Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: After anesthesia induction TAPSE (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (RVEF; p=0.1607) and right ventricular stroke volume (RVSV; p=0.1838) did not change. Conclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration: Retrospecitvely registered, 6 th June 2016, ClinicalTrials.gov Identifier NCT02820727.
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Magunia et al. (2019) conducted an observational in Elective cardiac surgery (n=53). Anesthesia induction and positive pressure ventilation vs. Baseline (spontaneous ventilation before induction) was evaluated on Tricuspid annular plane systolic excursion (TAPSE) (MD -1.6 mm, 95% CI -2.6 to -0.7, p=0.0013). Anesthesia induction and positive pressure ventilation significantly reduced longitudinal right ventricular function, including a 1.6 mm decrease in TAPSE, while preserving global right ventricular ejection fraction and stroke volume.
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