【 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
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.