The Effects of Nitrous Oxide on Left Ventricular Systolic and Diastolic Performance Before and After Cardiopulmonary Bypass

Abstract

We investigated the effects of nitrous oxide (N2 O) on central hemodynamics and left ventricular systolic and diastolic function in 25 patients undergoing coronary artery bypass surgery.All patients were receiving beta-blockers and had good left ventricular function. Global and regional systolic left ventricular performance and diastolic function were determined by computer-assisted analysis of transesophageal echocardiographic (TEE) images, and mitral Doppler flow profiles, respectively. The patients were anesthetized with fentanyl and ventilated with oxygen in air. Hemodynamic and TEE measurements were obtained before and after the introduction of N2 O in oxygen (60%/40%), before and after cardiopulmonary bypass (CPB). N2 O reduced mean arterial pressure, heart rate, stroke volume, and cardiac output both before and after CPB. Left ventricular global area ejection fraction (GAEF) was not changed by the introduction of N2 O, either before or after CPB. N2 O induced a significant change in regional wall motion after, but not before CPB, as assessed by the relationship between segmental area ejection fraction (SAEF) and GAEF. Analysis of the mitral flow profile indicated an increase in early diastolic relaxation in the pre-CPB period after introduction of N2 O, that was absent in the post-CPB period. We conclude that N2 O induces regional wall motion abnormalities and possibly diastolic dysfunction post-CPB. (Anesth Analg 1995;81:243-8)