Key result
Anesthesia induction and positive pressure ventilation significantly reduced baso-apical right ventricular function (TAPSE MD -1.6 mm), while preserving global ejection fraction and stroke volume.
Why the study?
General anesthesia induction with positive pressure ventilation creates a vulnerable phase, and the impact of positive intrathoracic pressure on cardiac performance remains controversial.
Does anesthesia induction with positive pressure ventilation alter echocardiography-derived parameters of right ventricular function in patients undergoing elective cardiac surgery?
Observational (n=53)
No
Does anesthesia induction with positive pressure ventilation alter echocardiography-derived parameters of 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 and positive pressure ventilation in cardiac surgery patients reduces baso-apical right ventricular function but preserves global right ventricular ejection fraction and stroke volume.
Reduced post-induction TAPSE does not imply global RV impairment; leaves open clinical relevance for perioperative monitoring.
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, 6th 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) 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 baso-apical right ventricular function (TAPSE MD -1.6 mm), while preserving global ejection fraction and stroke volume.
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