• Users Online: 132
  • Print this page
  • Email this page
ORIGINAL RESEARCH
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 227-231

Effect of General Endotracheal Anesthesia and Mechanical Ventilation on the Echocardiographic Measurements in Severe Aortic Stenosis


1 Department of Anesthesiology and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bengaluru, Karnataka, India
2 Department of Anesthesiology, M Health Fairview, University of Minnesota, Minneapolis, MN, USA

Correspondence Address:
Dr. Muralidhar Kanchi
Department of Anesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Hrudayalaya Health City, Bommasandra Industrial Area, Anekal Taluk, Bengaluru - 560 099, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_17_20

Rights and Permissions

Introduction: We measured the peak pressure gradient (pPG) and mean pressure gradient (mPG) obtained by transesophageal echocardiography (TEE) after induction of anesthesia and compared it with the preoperative pPG and mPG by transthoracic echocardiography (TTE) in adults with aortic stenosis (AS). We also compared the aortic valve area (AVA) measurements as obtained preoperatively by TTE versus those by TEE following induction of general endotracheal anesthesia (GETA) during the inspiratory phase, expiratory phase of the ventilatory cycle and with incremental increases in tidal volume. Materials and Methods: All patients had preoperative TTE within 1 month of surgery and was reviewed 1 day before the surgery. After anesthetic induction, precardiopulmonary bypass (CPB) TEE evaluation was done to measure mPG and pPG across AV, under steady-state conditions. Three different controlled tidal volumes: 8 ml, 10 ml, and 12 ml per kg body weight were utilized during the TEE measurements. Results: A total of 90 adults underwent aortic valve replacement from 2017 to 2018. The preoperative pPG and mPG across the AV by TTE was 96.7 ± 23.27 mmHg and 60.7 ± 18.1 mmHg, respectively. Compared to preoperative TTE, pre-CPB TEE pressure gradient during both phases of ventilation under GETA was significantly lower. The pPG and mPG were higher during inspiration as compared to those in the expiratory cycle during mechanical ventilation under GETA (pPG during inspiration = 66.63 ± 22.15 mmHg; mPG during inspiration = 38.24 ± 13.65 mmHg; pPG during expiration = 52.49 ± 19.10 mmHg; mPG during expiration = 30.76 ± 12.66 mmHg). There were no significant changes in AVA between TTE/TEE and inspiration/expiration. Conclusions: The findings of this study demonstrate that the TEE pre-CPB PGs underestimated the severity of AS; hence, the severity of AS must be interpreted with caution during GETA and mechanical ventilation (MV). In addition, PGs must be done at similar points in the respiratory cycle.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed584    
    Printed18    
    Emailed0    
    PDF Downloaded79    
    Comments [Add]    

Recommend this journal