Right Ventricular Dysfunction
Conditions
Brief summary
The investigator hypothesize that High Spinal Anesthesia (HSA) by its effect on attenuation of stress response, decrease in pulmonary vascular resistance, myocardial protection and positive myocardial oxygen balance will cause improvement in right ventricular function. So far there is no study that has evaluated the effect of HSA anesthesia on the right ventricular function, hence the investigator planned this study to compare the effect of HSA on the right ventricular function in patients with mitral valve disease with moderate to severe pulmonary hypertension planned for mitral valve replacement surgery.
Detailed description
All study patients will undergo routine TTE and TEE examination protocol followed at the investigator institution. All the other routine monitoring such as end tidal carbon dioxide, urine output, ABG, ACT, BIS, electrolytes, blood sugar, hemoglobin and ventilatory parameters etc for open heart surgery will be done as per institutional practice. In the study group, the patients will receive spinal anesthesia after placement of invasive lines and prior to induction of GA.In both the study group GA will be induced with midazolam 1-2 mg, fentanyl 2μ/kg and propofol titrated to achieve loss of consciousness. Inj. Vecuronium bromide 0.1mg/kg will be used as muscle relaxant to facilitate tracheal intubation and lignocaine spray (LOX 10% spray, Neon laboratories LTD, Thane, India) will be used over vocal cords prior to intubation to blunt the sympathetic stimulation. Subsequently anesthesia will be maintained in both the groups, with isoflurane inhalation to maintain BIS values between 40 to 60. In control group, fentanyl infusion 1μ/kg/hr will be started for analgesia, a similar looking infusion without fentanyl will be started in the spinal group.All patients will be shifted to ICU with inotropic and vasopressor support as per the hemodynamic condition.
Interventions
PROCEDURESpinal anesthesia with Bupivacaine heavy and Morphine
Spinal anesthesia with Bupivacaine heavy 40 mg and Morphine 250 micro grams will be given to patient in addition to the routine general anesthesia before the start of surgery
DRUGBupivacaine heavy and Morphine
Sponsors
Post Graduate Institute of Medical Education and Research, Chandigarh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 50 consecutive patients of 18 to 60 years age, * NYHA class II or III, * with mitral valvular disease with moderate to severe PAH (mean pulmonary artery pressure \> 40 mmHg) undergoing MVR
Exclusion criteria
* emergency or redo surgery, patients with associated CAD or other valvular heart disease, * COPD, * bronchial asthma, * obesity (BMI more than 30), anticipated difficult airway, * opioid drug abuse or addiction and those with contraindication for spinal anaesthesia including local site infection, * spinal deformity, deranged coagulogram defined by platelet count \< 80,000 & INR \> 1.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Improvement of right ventricular function defined by 20% increase in the TAPSE in the study group when compared to the control group | Till patient got discharged from ICU, an average of 5 days |
Secondary
| Measure | Time frame |
|---|---|
| Pulmonary vascular resistance | Till patient got discharged from ICU, an average of 5 days |
| Left ventricular ejection fraction | Till patient got discharged from ICU, an average of 5 days |
| Right ventricular myocardial performance index | Till patient got discharged from ICU, an average of 5 days |
| Mechanical ventilation duration | Till patient got discharged from ICU, an average of 5 days |
| Intensive care unit stay | Till patient got discharged from ICU, an average of 5 days |
Countries
India
Outcome results
None listed