Effects of anaesthetic aggents on cardiac functions in the patients with cardiac risks

PURPOSE: We aimed to compare hymodinamic parameters that shows myocardial functions effected by different fresh gas flows, during cardiovasculer surgery with using non-invasive measurement methods.MATERIAL AND METHOD: 41 volunteers, aged 40-80 years, ASA I-III, undergoing CABG surgery were enrolled to the study. Patients were divided randomly to four Groups. Rutine monitorization was applied and CO, SV and SVR measurements were recorded. In Group I, 2 l/ m flow rate at 1 MAC sevoflurane, In Group II, 4,4 l/ m flow rate at 1 MAC sevoflurane, In Group III, 2 l/ m flow rate at 1 MAC izoflurane, Group IV, 4,4 l/ m flow rate at 1 MAC izoflurane. For all patients, the measurement values at 1: 5. minute of entubation, 2: 5 minute after sternotomy, 3: before CPB, 4: after CPB, 5: 5 minute after sternum closed, recorded. P 0.005 accepted significant.RESULTS: CO measurements, performed with HemoSonic method, between Group I and II before CPB in Group II founded higher. In Group IV, CO values founded higher before CPB and after sternum closed, than Group II. When HemoSonic and NICO methods were compared, NICO measurement values founded high before CPB and HemoSonic measurement values founded high after CPB and after sternum closed. Between Groups I-III, I-IV and II-IV, SV values, performed with HemoSonic were seen different. SV values founded for these Groups, when compared in order there was an increase from Group I to Group IV. SVR measurement values performed with HemoSonic, founded different after sternotomy, between Groups I-IV, II-IV and III-IV. The values in Group IV were founded lower than other Groups. NICO measurements were seen different, after entubation after sternotomy between Groups II and III. For these measurement values, the values were higher in Group III. And also between Group III-IV, the values measured after entubation and after sternotomy were founded significant.When the changes in Groups during operation were compared, CO values were not different in Group I. But in NICO measurement values, there was a decrease in the values before CPB. There was no difference in the measurement values in Group II. In Group III, there was a decrease determined before CPB and there was an increase determined in Group IV after sternotomy. In NICO measurement values, a decrease determined before CPB. In Group II, SV values determined low before CPB and also there was a decrease at fifth measurement than first measurement. In Group III after sternotomy and before CPB low SV values, after sternum closed high SV values founded. In Group IV there was no difference for measurement values, performed with HemoSonic, but there was a decrease for values measured before CPB, performed with NICO. There was no differnce, in Group I for SVR measurement values. In Group II, after CPB SVR values measured low, and also at fifth measurement low values measured than firrst measurement values. In Group III there was a increase after sternotomy and a decrease before CPB determined. Before CPB and after entubation there was a decrease determined for values when compared with after sternum closed, with NICO. In Group IV, after sternotomy and after entubation there was a decrease determined for values compared to values after sternum closed. The mesurement performed with NICO, there was a decrase determined after sternum closed.CONCLUSION: During CABG, for protecting cardiac functions sevoflurane and izoflurane efficiant, in patients with cardiac risks. But in sevoflurane anesthesia, hemodinamy is more stabil, and for this reasone sevoflurane must be preferred. We concluded that in low flow anesthetic use, hemodynamic datas will be approach to values measured before CPB. When a non-invasive measurement method determining for controlling hemodynamy, method?s working principials and suitibility to the patient must be carefully evulated.