Echocardiography for Anesthesia Effects on Heart Function
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Memorial Sloan Kettering Cancer Center
Must not be taking: Beta-blockers, Anti-hypertensives
Disqualifiers: Coronary artery disease, Cardiac disease, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This trial studies how general anesthesia affects heart function and blood flow in people who experience low blood pressure during surgery.
Will I have to stop taking my current medications?
If you are taking beta-blockers or anti-hypertensive medications, you will need to stop taking them to participate in this trial.
What data supports the effectiveness of the treatment Echocardiography for Anesthesia Effects on Heart Function?
Echocardiography, a heart imaging technique, is shown to be a noninvasive and safe method for assessing heart function during surgery, which can help manage anesthesia and monitor heart performance effectively.
12345Is echocardiography safe for use in humans during anesthesia?
Echocardiography is a non-invasive and safe method used to assess heart function during anesthesia. It has been widely adopted in cardiac anesthesia and critical care without reported safety concerns.
12678How is echocardiography used to assess anesthesia effects on heart function different from other treatments?
Echocardiography is unique because it is a non-invasive imaging technique that allows doctors to see how the heart is functioning in real-time during anesthesia, unlike other treatments that may not provide immediate visual feedback on heart performance.
2791011Eligibility Criteria
This trial is for adults over 18 who need general anesthesia for surgery, with at least a 20-minute prep time before incision and normal blood pressure. It's not for those in emergency surgery, on anti-hypertensive or beta-blocker medications, or with a history of heart disease.Inclusion Criteria
I am 18 or older and need general anesthesia for surgery.
My surgery is expected to start 20 minutes after preparation.
I will need a breathing tube for my surgery.
+1 more
Exclusion Criteria
I need a fast process for being put on a breathing machine.
I have a history of heart artery problems.
I need emergency surgery.
+5 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants undergo routine anesthetic and perioperative care with the addition of echocardiography and Clearsight BP measurement
During surgery
1 visit (in-person)
Follow-up
Participants are monitored for changes in heart function and blood flow post-anesthesia
up to 20 minutes after anesthesia induction
Participant Groups
The study uses echocardiography to observe how general anesthesia affects heart function and blood flow during surgery, especially when patients have low blood pressure after receiving anesthesia.
1Treatment groups
Experimental Treatment
Group I: EchocardiographyExperimental Treatment1 Intervention
Patients participating in this study will undergo routine anesthetic and perioperative care with the addition of an echocardiography and Clearsight BP measurement.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Memorial Sloan Kettering Cancer Center (All protocol activites)New York, NY
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Who Is Running the Clinical Trial?
Memorial Sloan Kettering Cancer CenterLead Sponsor
References
Effect of performing preoperative echocardiography in patients with cardiovascular risk on intraoperative anesthetic management and postoperative outcomes: A retrospective study. [2022]Although echocardiography is widely used for preoperative cardiac risk evaluation, few studies have analyzed the effect of performing preoperative echocardiography on intraoperative anesthetic management and postoperative outcomes. We investigated the effect of performing echocardiography on intraoperative anesthetic management and postoperative outcomes in patients with cardiovascular risk. We retrospectively evaluated patients who had undergone major abdominal surgery and satisfied 2 or more of the following criteria: hypertension, diabetes mellitus, age ≥70 years, and previous cardiac disease. Patients were categorized into a group in which preoperative echocardiography was performed (echo) and a group in which it was not (non-echo). The primary outcomes were postoperative 30-day mortality and incidence of cardiovascular complications. Secondary outcomes were length of hospital stay, intraoperative incidence of hypotension, use of vasopressors, and findings on intraoperative invasive hemodynamic monitoring. There were no differences in 30-day mortality, incidence of postoperative cardiovascular complications, length of hospital stay, and intraoperative events between the groups. Only the incidence of cardiac output monitoring was lower in the echo group than in the non-echo group (59.6% vs 73.9%). Preoperative echocardiography does not affect postoperative outcomes, but it has the potential to affect intraoperative anesthetic management such as invasive hemodynamic monitoring during surgery.
Noteworthy Literature published in 2017 for Perioperative Echocardiography. [2018]In this inaugural review, we present noteworthy advances in perioperative echocardiography relevant to the cardiac anesthesiologist. These studies come from different clinical realms including advances in mitral valve imaging, perioperative echocardiographic evaluation, and critical care echocardiography. The importance of perioperative echocardiography continues to grow with cardiac anesthesiologists positioned in a critical role throughout the perioperative care continuum.
Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients. [2019]To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery.
[Noninvasive monitoring using echocardiography. II. Determination of cardiac output and comparison of volatile anesthetics]. [2013]In order to prove definitely that echocardiography is a noninvasive and safe method that can be used in the perioperative period to assess cardiac function and evaluate the effects of pharmacologic agents on the heart, we have carried out further sonographic studies concerning cardiac output and the effects of volatile anesthetics on left ventricular contractility. In series A (n = 12), we compared different sonographic techniques (uni-dimensional, two-dimensional, pulse Doppler echocardiography) with invasively measuring cardiac output by thermodilution in ICU patients and in the immediate preoperative phase before CABG with a Swan Ganz catheter that was already inserted. M-mode echocardiography proved to be best and correlated well with invasively gained values (y = 0.57 + 0.96x, r = 0.795, p less than 0.01). Use of the Teichholtz formula to estimate left ventricle volumes seems to be imperative. The two-dimensional technique yielded less favorable results, the pulse Doppler method being least informative. In series B (n1 = n2 = n3 = 6) the effects of halothane, enflurane and isoflurane MAC 1.0 and 1.5 on left ventricular performance were assessed in patients undergoing cholecystectomy or gastrectomy under standard anesthetic conditions. The results support the already well-known pharmacologic effects of these drugs, with minimal decrease in contraction with isoflurane. Critical interpretation of the different sonographic parameters, however, is just as important as considering various existing interdependances. Finally, when comparing our numerical values with other 1.0 MAC effects reported in the literature, there was also very good agreement.(ABSTRACT TRUNCATED AT 250 WORDS)
Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: feasible and alters patient management. [2022]The aim of this study was to assess the feasibility and effects on perioperative management of a focused transthoracic echocardiogram performed by anesthesiologists.
[The role of echocardiography in preoperative diagnosis of cardiac risk in patients before non-cardiac surgical interventions]. [2016]Echocardiography is a noninvasive method for cardiac evaluation. A review of the current literature shows that the routine use of echocardiography for assessing perioperative cardiac risk in patients undergoing noncardiac surgery can not be supported. Only patients with suspected relevant heart valve diseases, acute heart failure, cardiomyopathy or condition after heart or heart-lung transplantation may benefit from preoperative echocardiography. In patients with suspected or proven coronary artery disease stress echocardiography offers the most relevant additional information for the anaesthesiologist. However, because of the high financial and personal implications it should be reserved to those patients who are not able to perform a normal stress test. Besides in patients in whom transthoracic echocardiography doesn't offer sufficient information or is not possible transesophageal echocardiography plays only a minor role in preoperative cardiac evaluation.
Echocardiographic assessment of ventricular performance following induction with two anesthetics. [2019]Echocardiographic studies were made of 20 healthy patients scheduled for minor surgical procedures to determine whether this technique could be used routinely in the operating room and to evaluate the effects of halothane and enflurane on left ventricular performance. Thirteen minutes following induction of anesthesia with halothane in ten patients (mean end-tidal halothane concentration 0.93 per cent), mean arterial blood pressure, left ventricular (LV) diastolic dimension, LV fractional shortening, mean velocity of circumferential fiber shortening and systolic thickening of the posterior LV wall were significantly decreased. LV systolic dimension was increased significantly. These data indicate that halothane caused decreased contractility in the presence of a decreased afterload. Twelve minutes following induction of anesthesia with enflurane in ten patients (mean delivered enflurane concentration 2.4 per cent), mean arterial blood pressure and LV systolic and diastolic dimensions were decreased, while heart rate was increased significantly, indicating that enflurane caused vasodilatation and may have had some depressant effect on contractility. Echocardiography is a non-invasive, safe and relatively rapid method that can be used in the perioperative period to assess cardiac function and to evaluate the effects of pharmacologic agents on the heart.
A review of echocardiography in anaesthetic and peri-operative practice. Part 2: training and accreditation. [2015]Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri-operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. There are a number of existing clinical protocols for the use of transthoracic echocardiography with a focused approach. Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills--these encompass clinical, simulation and online resources. Whilst the roll-out of echocardiography for more widespread use in peri-operative management is a long-term project, it is now an appropriate time to consider how this may be achieved.
Effects of isoflurane concentration on basic echocardiographic parameters of the left ventricle in rats. [2020]Transthoracic echocardiography (TTE) has become an important modality for the assessment of cardiac structure and function in animal experiments. The acquisition of echocardiographic images in rats requires sedation/anesthesia to keep the rats immobile. Commonly used anesthetic regimens include intraperitoneal or inhalational application of various anesthetics. Several studies have compared the effects of anesthetic agents on echocardiographic parameters in rats; however, none of them examined the effects of different concentrations of inhalational anesthetics on echocardiographic parameters. Accordingly, the aim of this study was to examine the effects of different concentrations of isoflurane used for anesthesia during TTE examination in rats on basic echocardiographic parameters of left ventricular (LV) anatomy and systolic function. TTE examinations were performed in adult male Wistar rats (n=10) anesthetized with isoflurane at concentrations of 1.5-3 %. Standard echocardiograms were recorded for off-line analysis. An absence of changes in basic echocardiographic parameters of LV anatomy and systolic function was found under isoflurane anesthesia using concentrations between 1.5-2.5 %. An isoflurane concentration of 3 % caused a small, but statistically significant, increase in LV chamber dimensions without a concomitant change in heart rate or fractional shortening. For the purpose of TTE examination in the rat, our results suggest that isoflurane concentrations
Effects of anesthesia on echocardiographic assessment of left ventricular structure and function in rats. [2022]Echocardiography is an essential diagnostic tool for accurate noninvasive assessment of cardiac structure and function in vivo. However, the use of anesthetic agents during echocardiographic studies is associated with alterations in cardiac anatomical and functional parameters. We sought to systematically compare the effects of three commonly used anesthetic agents on echocardiographic measurements of left ventricular (LV) systolic and diastolic function, LV dimensions, and LV mass in rats. Adult male Fischer 344 rats underwent echocardiographic studies under pentobarbital (PB, 25 mg/kg i.p.) (group I, n = 25), inhaled isoflurane (ISF, 1.5%) (group II, n = 25),or ketamine/xylazine (K/X, 37 mg/kg ketamine and 7 mg/kg xylazine i.p.) (group III, n = 25) anesthesia in a cross-over design. Echocardiography was also performed in an additional group of unanesthetized conscious rats (group IV, n = 5). Postmortem studies were performed to validate echocardiographic assessment of LV dimension and mass. Rats in group I exhibited significantly higher LV ejection fraction, fractional shortening, fractional area change, velocity of circumferential fiber shortening corrected for heart rate, and heart rate as compared with groups II and III. LV end-diastolic volume, end-diastolic diameter, and cross-sectional area in diastole were significantly smaller in group I compared with groups II and III. Cardiac output was significantly lower in group III compared with groups I and II. Postmortem LV mass measurements correlated well with echocardiographic estimation of LV mass for all anesthetic agents, and the correlation was best with PB anesthesia. Limited echocardiographic data obtained in conscious rats were similar to those obtained under PB anesthesia. We conclude that compared with ISF and K/X anesthesia, PB anesthesia at a lower dose yields echocardiographic LV structural and functional data similar to those obtained in conscious rats. In addition, PB anesthesia also facilitates more accurate estimation of LV mass.
Decline in ventricular function as a result of general anesthesia in pediatric heart transplant recipients. [2018]Echocardiography is frequently performed under anesthesia during procedures such as cardiac catheterization with EMB in pediatric HTx recipients. Anesthetic agents may depress ventricular function, resulting in concern for rejection. The aim of this study was to compare ventricular function as measured by echocardiography before and during GA in 17 pediatric HTx recipients. Nearly all markers of ventricular systolic function were significantly decreased under GA, including EF (-4.2% ±1.2, P