Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844772
Brazilian Journal of Anesthesiology
Original Investigation

Effects of propofol versus sevoflurane induction on echocardiographic parameters in patients with mitral stenosis: a randomized clinical trial

Efeitos da indução com propofol versus sevoflurano nos parâmetros ecocardiográficos em pacientes com estenose mitral: um ensaio clínico randomizado

Mohammed Jaffer Sherif, Saravana Babu MS, Prasanta Kumar Dash, Nagarjuna Panidappu, Subin Sukesan, Thomas Koshy

http://dx.doi.org/10.1016/j.bjane.2026.844772 Braz J Anesthesiol, vol.76, n4, 844772, 2026
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Abstract

Background

The main aim of this study was to compare the effects of propofol and sevoflurane induction on the echocardiographic parameters of Mitral Stenosis (MS) patients.

Methods

Prospective, randomized, outcome-assessor-blinded clinical trial in 80 adults with MS undergoing mitral valve replacement. Patients were randomized to receive General Anesthesia (GA) induction with either propofol (Group P) or sevoflurane (Group S). The primary objective was to assess the changes in mean gradient after 3 minutes of GA induction. Secondary objectives were to assess the changes in echocardiographic Doppler parameters and hemodynamic variables.

Results

Compared to pre-induction values, there was significant reduction in the peak and mean gradients as well as peak velocity, in both the groups after GA induction. The Mitral Valve Area calculated by continuity equation (MVA-c) and by pressure half time (MVA-p) were increased in Group S after GA induction. On comparison between the two groups, Group S showed lower pressure half time and greater MVA-p (p = 0.0099) and MVA-c (p = 0.0316) than Group P after GA induction. Mean arterial pressure decreased at the 1st and 3rd minute following GA induction in both groups. The Heart Rate (HR) increased at the 1st and 3rd minute in Group P whereas it reduced at both the time points in group S.

Conclusion

Even though both anesthetic agents reduced transvalvular gradients in MS patients, sevoflurane was associated with a greater increase in estimated valve area and a reduction in heart rate compared with propofol. These findings suggest more favorable short-term hemodynamic and echocardiographic changes with sevoflurane at the studied time points.

Keywords

Anesthetics, Inhalation; Anesthetics, Intravenous; Echocardiography; Mitral valve stenosis; Propofol; Sevoflurane

Resumo

Introdução

O objetivo principal deste estudo foi comparar os efeitos da indução com propofol e sevoflurano nos parâmetros ecocardiográficos de pacientes com estenose mitral (EM).

Métodos

Ensaio clínico prospectivo, randomizado e cego para o avaliador do desfecho em 80 adultos com EM submetidos à troca da valva mitral. Os pacientes foram randomizados para receber indução de anestesia geral (AG) com propofol (Grupo P) ou sevoflurano (Grupo S). O objetivo primário foi avaliar as alterações no gradiente médio após 3 minutos da indução da AG. Os objetivos secundários foram avaliar as alterações nos parâmetros Doppler ecocardiográficos e variáveis hemodinâmicas.

Resultados

Em comparação com os valores pré-indução, houve redução significativa nos gradientes de pico e médio, bem como na velocidade de pico, em ambos os grupos após a indução da AG. A área da valva mitral calculada pela equação de continuidade (AVM-c) e pelo tempo de meia-pressão (AVM-p) aumentou no Grupo S após a indução da AG. Na comparação entre os dois grupos, o Grupo S apresentou menor tempo de meia-pressão e maior AVM-p (p = 0,0099) e AVM-c (p = 0,0316) do que o Grupo P após a indução da AG. A pressão arterial média diminuiu no 1º e 3º minutos após a indução da AG em ambos os grupos. A frequência cardíaca (FC) aumentou no 1º e 3º minutos no Grupo P, enquanto reduziu em ambos os momentos no Grupo S.

Conclusão

Embora ambos os agentes anestésicos tenham reduzido os gradientes transvalvulares em pacientes com EM, o sevoflurano foi associado a um maior aumento na área valvar estimada e a uma redução na frequência cardíaca em comparação com o propofol. Esses achados sugerem alterações hemodinâmicas e ecocardiográficas de curto prazo mais favoráveis com o sevoflurano nos momentos estudados.

Palavras-chave

Anestésicos por inalação; Anestésicos intravenosos; Ecocardiografia; Estenose da valva mitral; Propofol; Sevoflurano

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Submitted date:
07/22/2025

Accepted date:
05/15/2026

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