Remifentanil diastolik disfonksiyonu olan hastalarda sol ventrikül fonksiyonunu iyileştirir: prospektif klinik çalışma.
Özge Köner, Mustafa Aytek Şimşek, Nurcan Kızılcık, Çiğdem Koca, Ayça Türer Cabbar
Yeditepe University Medical Faculty
Giriş: Left ventricular diastolic dysfunction has a significant impact on peri-operative morbidity, mortality (1,2). Its incidence is high in the elderly. Anesthetics may lead to diastolic dysfunction in patients with diastolic dysfunction (3,4). The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle function in patients with diastolic dysfunction.
Gereç ve Yöntem: Thirty spontaneously breathing subjects (60–80 years) with diastolic dysfunction were enrolled. Following baseline measurements, indices of left ventricle function were evaluated once the iv remifentanil infusion reached a concentration of 2 ngml-1 with TTE. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm) change from the baseline, whereas diastolic function focused on changes in transmitral peak flow (E), E/A and E/e’ ratios following remifentanil infusion. Sample size calculation was based on a preliminary study performed on 12 patients to detect a 15% change in E/e’ (α0.05;β>0.8). Within group comparisons were performed with repeated measures of ANOVA, Friedman tests.
Bulgular: Demographic and clinical data are presented in table 1. Diastolic function measures (mitral E/e’, septal and lateral e’ waves) significantly improved (E/e’ from 10.58±2.94 cm sn-1 to 9.54±2.26 cm sn-1; p=0.006), while other diastolic functions measures of left ventricle (left atrial volume, E/A, E) remained unchanged following remifentanil infusion . Systolic function measures (ejection fraction and Sm) have not changed following remifentanil infusion(table 3).Haemodynamic data, oxygen saturation, sedation scores are shown in table 2. Remifentanil related side effects are shown in table 4.
Tartışma ve Sonuç: In conclusion, remifentanil improved left ventricle diastolic function without a change in systolic function in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a target concentration of 2 ng ml-1 might be used safely in patients with left ventricular diastolic dysfunction.
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