Baiterek Bekzat Askaruly, Mustafin Alibek
Astana Medical University, Nur-Sultan, Kazakhstan.
Departments of Anesthesiology, Resuscitation and Intensive Care Unit Medical Centre, Hospital of President's Affairs Administration of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan.
Anesth Pain Med. 2023 Mar 14;13(2):e134119. doi: 10.5812/aapm-134119. eCollection 2023 Apr.
Cardiac index (CI) and metabolic response to surgery are important indicators of the course of the intraoperative period.
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.
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.
The use of anesthetics did not change CI. Cardiac index decreased from 3 to 2.9 L/min/m in the propofol group, increased from 3.1 to 3.2 L/min/m in the sevoflurane group, and decreased from 2.9 to 2.7 L/min/m in the isoflurane group. Compared to inhaled anesthetics, propofol significantly reduced VO from 179.1 to 135.7 mL/min/m. Propofol reduced energy expenditure from 1483.7 to 1333.5 kcal.
Volatile anesthetics, propofol has practically no effect on CI in an uncomplicated surgery. Anesthesia with propofol is associated with lower VO and better oxygen delivery to tissues. Energy consumption during propofol anesthesia decreases.
心脏指数（CI）和手术代谢反应是术中期进程的重要指标。
本研究旨在确定七氟烷、异氟烷和丙泊酚对成人主动脉瓣和二尖瓣置换术中CI及代谢结果的影响。
在这项单中心前瞻性随机对照临床研究中，根据麻醉类型将75例患者随机分为3组：丙泊酚组（n = 25）、七氟烷组（n = 25）和异氟烷组（n = 25）。通过食管超声心动图测定心脏每搏输出量（SV）（SV = 舒张末期容积 - 收缩末期容积）。根据公式计算心输出量（CO）和CI。手术中的耗氧量 = CI×动静脉差值。使用肺活量测定仪通过间接测热法确定麻醉期间的能量消耗。
麻醉药物的使用未改变CI。丙泊酚组的心脏指数从3降至2.9 L/min/m²，七氟烷组从3.1升至3.2 L/min/m²，异氟烷组从2.9降至2.7 L/min/m²。与吸入麻醉药相比，丙泊酚显著将VO从179.1降至135.7 mL/min/m²。丙泊酚使能量消耗从1483.7降至1333.5千卡。
在简单手术中，挥发性麻醉药丙泊酚对CI几乎没有影响。丙泊酚麻醉与较低的VO及更好的组织氧输送相关。丙泊酚麻醉期间的能量消耗降低。
