[in Japanese]

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【 Objectives】 We performed a systematic review of randomized controlled trials （RCTs） to assess the effects of inotropic agent administration on left ventricular diastolic function in adult cardiac surgery patients. 【 Methods】 A systematic search was conducted using Medline and PubMed during the period between January 2003 and October 2017. Inclusion criteria were RCTs conducted in adult patients to assess effects of inotropic agent administration on left ventricular diastolic function using transesophageal echocardiography during the operation. Non-English language papers, animal studies, pediatric studies, and in vitro studies were excluded. 【Results】 Seven RCTs were selected to assess the effects of inotropic agents on left ventricular diastolic function. Four inotropic agents including epinephrine, milrinone, enoximone and levosimendan were evaluated in those RCTs. Epinephrine administration and milrinone administration were evaluated in 2 RCTs and 4 RCTs, respectively, and there was no significant difference in left ventricular diastolic function. Enoximone administration was studied in one RCT and it improved Dct and S/D significantly. However, this change using enoximone was comparable to that in the control group. Levosimendan administration was evaluated in 2 RCTs and it significantly improved left ventricular diastolic function as indicated by measurements of DcT, IVRT, E/E’ and Vp. 【Conclusions】 In our systematic review, we found that there is still limited information on the effects of inotropic agents on left ventricular diastolic function in adult cardiac surgery patients. Results of RCTs suggested that administration of levosimendan, but not administration of other inotropic agents, may improve left ventricular diastolic function.

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Hypertrophic cardiomyopathy(HCM) is a condition characterized by thickening of the heart muscle. This causes mid-systolic ventricular obstruction and/or left ventricular outflow tract obstruction, which can have an impact on the arterial waveform. The FloTrac/EV1000TM system is a non-invasive hemodynamic monitor that uses arterial pressure waveform analysis and is currently used for patients with cardiac compromise. However, little is known about the reliability of this system in HCM patients. A 19-year-old male patient who has been treated for HCM was scheduled for resection of the nerve of pterygoid canal for treatment of allergic rhinitis. Invasive arterial pressure monitoring that connected to the FloTrac/EV1000TM system was initiated. However, after induction of general anesthesia, the system started indicating very low cardiac index and even stopped measurement. All the other hemodynamic parameters seemed to be in the normal range. Here we describe the limitation of the FloTrac/EV1000TM system for an anesthetized patient with HCM.

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