Echocardiography for Anesthesia Effects on Heart Function

Overseen By Gregory Fischer, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Memorial Sloan Kettering Cancer Center

Must not be taking: Beta-blockers, Anti-hypertensives

Disqualifiers: Coronary artery disease, Cardiac disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: During surgery

250 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how general anesthesia affects heart function and blood flow, particularly in individuals who experience low blood pressure after receiving anesthesia. Participants will undergo echocardiography, a type of ultrasound for the heart, to monitor these changes. The trial suits adults who require general anesthesia and intubation for surgery and have stable blood pressure beforehand. Individuals with a history of heart issues or on specific heart medications are not eligible. As a Phase 2 trial, this research measures the treatment's effectiveness in an initial, smaller group, offering participants a chance to contribute to important medical advancements.

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 prior data suggests that echocardiography is safe for assessing heart function during anesthesia?

Studies have shown that echocardiography provides a safe and non-invasive method to check heart function during anesthesia. Doctors commonly use it in heart surgeries to assess how well the heart pumps and how blood flows while patients are under anesthesia. Since echocardiography involves no cutting or insertion of devices into the body, it carries very low risk. No reports of serious side effects have emerged from using echocardiography in these situations, making it a well-tolerated option for monitoring heart function during surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using echocardiography to study anesthesia's effects on heart function because it provides real-time, detailed images of the heart. Unlike traditional methods that might rely solely on blood pressure monitoring or indirect heart function assessments, echocardiography offers a direct look at how the heart is working during surgery. This technique, combined with Clearsight BP measurement, could lead to better understanding and management of heart function under anesthesia, potentially improving patient outcomes in surgical settings.

What evidence suggests that echocardiography is effective for assessing heart function changes during anesthesia?

Research has shown that echocardiography, a type of heart ultrasound, provides detailed information about heart function, fluid levels, and blood flow during anesthesia. This tool aids doctors in managing anesthesia, particularly during surgery. Studies have found that general anesthesia can affect heart function, and echocardiography monitors these changes. Although it does not directly alter surgery outcomes, it enables doctors to adjust anesthesia safely. By enhancing understanding of heart function, echocardiography supports safer care for patients with low blood pressure during surgery. ^{1 3 6 7 8}

Who Is on the Research Team?

Anahita Dabo-Trubelja, MD

Principal Investigator

Memorial Sloan Kettering Cancer Center

Are You a Good Fit for This Trial?

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.

Baseline MAP >70mmHg

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.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Echocardiography

Trial Overview 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.

How Is the Trial Designed?

Group I: Echocardiography Experimental Treatment 1 Intervention

Patients participating in this study will undergo routine anesthetic and perioperative care with the addition of an echocardiography and Clearsight BP measurement.

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Published Research Related to This Trial

In a study of 17 pediatric heart transplant recipients, it was found that general anesthesia (GA) significantly decreased markers of ventricular function, including a 4.2% reduction in ejection fraction (EF) and a decrease in right ventricular fractional area change (RV FAC).

Younger patients in the first year post-transplant experienced a more pronounced decline in EF under GA, suggesting that clinicians should be aware of this temporary decrease in heart function to avoid misdiagnosing it as rejection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Decline in ventricular function as a result of general anesthesia in pediatric heart transplant recipients. Elhoff, JJ., Chowdhury, SM., Taylor, CL., et al.[2018]

Echocardiography is increasingly recognized as a valuable tool in cardiac anaesthesia and critical care, with potential benefits for broader use in anaesthesia and peri-operative practice.

Training and accreditation processes for echocardiography are being developed, including structured protocols like Focused Intensive Care Echocardiography in the UK, which provide learning opportunities for anaesthetists to enhance their skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of echocardiography in anaesthetic and peri-operative practice. Part 2: training and accreditation. Sharma, V., Fletcher, SN.[2015]

Anesthesiologists were able to successfully perform a focused transthoracic echocardiogram (FoCUS) in 98% of the 50 patients studied, providing high-quality diagnostic images that informed patient management.

The FoCUS led to changes in perioperative care for 84% of patients, demonstrating its effectiveness in guiding anesthesia and monitoring decisions, with major findings aligning with formal cardiology assessments in 87% of cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: feasible and alters patient management. Cowie, B.[2022]

In a study of 31 patients experiencing hemodynamic instability during noncardiac surgery, modified 'rescue' echocardiography successfully identified specific causes of instability in all cases, including left-heart dysfunction and hypovolemia.

The use of echocardiography led to timely interventions, with 13% of patients requiring and surviving an emergent secondary procedure, and 81% of patients ultimately being discharged from the hospital after recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients. Shillcutt, SK., Markin, NW., Montzingo, CR., et al.[2019]

Pentobarbital anesthesia provided the most accurate echocardiographic measurements of left ventricular (LV) function and structure in rats, yielding results similar to those obtained in conscious rats, which is important for ensuring reliable cardiac assessments.

In contrast, isoflurane and ketamine/xylazine anesthesia resulted in altered LV measurements, indicating that the choice of anesthetic can significantly impact the accuracy of echocardiographic evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of anesthesia on echocardiographic assessment of left ventricular structure and function in rats. Stein, AB., Tiwari, S., Thomas, P., et al.[2022]

Echocardiography is a safe and noninvasive method for assessing cardiac function during the perioperative period, with M-mode echocardiography showing strong correlation with invasive cardiac output measurements in a study of 12 ICU patients.

The study also confirmed that volatile anesthetics like isoflurane have minimal effects on left ventricular contractility, supporting existing knowledge about their pharmacologic properties in a controlled setting with 12 patients undergoing surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Noninvasive monitoring using echocardiography. II. Determination of cardiac output and comparison of volatile anesthetics]. Bergmann, H., Bergmann, H., Necek, S., et al.[2013]

Routine echocardiography is not recommended for assessing cardiac risk in patients undergoing noncardiac surgery, except for those with specific heart conditions like valve diseases or acute heart failure.

Stress echocardiography can provide valuable information for patients with suspected coronary artery disease, but it should be reserved for those who cannot perform standard stress tests due to its high costs and implications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The role of echocardiography in preoperative diagnosis of cardiac risk in patients before non-cardiac surgical interventions]. Strom, C., Kilger, E., von Scheidt, W., et al.[2016]

Recent advances in perioperative echocardiography are enhancing the ability of cardiac anesthesiologists to assess and manage patients during surgery, particularly in areas like mitral valve imaging and critical care.

The role of echocardiography in perioperative care is becoming increasingly important, highlighting the need for cardiac anesthesiologists to be proficient in these techniques to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Noteworthy Literature published in 2017 for Perioperative Echocardiography. Goeddel, LA., Kostibas, M., Metkus, T., et al.[2018]

Preoperative echocardiography in patients with cardiovascular risk undergoing major abdominal surgery did not lead to differences in 30-day mortality or postoperative cardiovascular complications, indicating it may not improve overall outcomes.

However, echocardiography was associated with a lower incidence of cardiac output monitoring during surgery, suggesting it may influence intraoperative anesthetic management practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of performing preoperative echocardiography in patients with cardiovascular risk on intraoperative anesthetic management and postoperative outcomes: A retrospective study. Park, JH., Park, YH., Lee, B., et al.[2022]

Echocardiographic assessments in 20 healthy patients undergoing minor surgery revealed that halothane anesthesia significantly decreased left ventricular contractility and altered heart dimensions, indicating potential cardiac effects during surgery.

Enflurane anesthesia also affected cardiac function by causing vasodilation and increasing heart rate, suggesting it may depress contractility as well; echocardiography proved to be a safe and effective tool for monitoring these changes in the operating room.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Echocardiographic assessment of ventricular performance following induction with two anesthetics. Rathod, R., Jacobs, HK., Kramer, NE., et al.[2019]

In a study involving 10 adult male Wistar rats, different concentrations of isoflurane (1.5-3%) were tested during transthoracic echocardiography (TTE) to assess their impact on left ventricular (LV) anatomy and function.

Isoflurane concentrations up to 2.5% did not affect echocardiographic parameters, while 3% caused a slight increase in LV chamber dimensions, suggesting that isoflurane concentrations of 2.5% or lower are safe for TTE examinations in rats.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of isoflurane concentration on basic echocardiographic parameters of the left ventricle in rats. Ríha, H., Papoušek, F., Neckář, J., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11486484/

Application of Echocardiography in Anaesthesia Echocardiography will provide all information related to cardiac function, fluid status, and hemodynamics that help guide anaesthetic management ...

2. withpower.com withpower.com/trial/phase-anaesthesia-therapy-6-2023-0c0d2

Echocardiography for Anesthesia Effects on Heart Function In a study of 17 pediatric heart transplant recipients, it was found that general anesthesia (GA) significantly decreased markers of ventricular function, ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1053077025002708

Special Article The Year in Perioperative Echocardiography This article is the ninth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography.

4. journals.lww.com journals.lww.com/md-journal/fulltext/2022/08260/effect_of_performing_preoperative_echocardiography.13.aspx

Effect of performing preoperative echocardiography in... Preoperative echocardiography does not affect postoperative outcomes, but it has the potential to affect intraoperative anesthetic management.

5. nature.com nature.com/articles/s41598-020-72924-5

The effect of different anaesthetics on echocardiographic ... Anaesthetics are well known to affect cardiac preload, afterload, myocardial contractility, and hemodynamics (e.g. heart rate). However, their ...

6. nature.com nature.com/articles/s41598-024-76279-z

Preoperative echocardiography and anesthetic drugs as ... Regarding the effects of anesthetics in cardiac patients, propofol has been reported to be associated with significant induction hypotension in ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0894731706006328

Impact of Anesthesia on Echocardiographic Evaluation ... The anesthetic agent has significant specific impacts on many echocardiographic measurements. Investigators working with rat models should be aware of those ...

8. apsf.org apsf.org/article/anesthetic-safety-considerations-for-off-site-cardiology-procedures/

Anesthetic Safety Considerations for Off-site Cardiology ... Recent data shows that benefits include less vasopressor use, a modest decrease in in-hospital mortality, shorter hospital length of stay, and more frequent ...