Document Detail


Desflurane, sevoflurane, and isoflurane impair canine left ventricular-arterial coupling and mechanical efficiency.
MedLine Citation:
PMID:  8712457     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effects of desflurane, sevoflurane, and isoflurane on left ventricular-arterial coupling and mechanical efficiency were examined and compared in acutely instrumented dogs. METHODS: Twenty-four open-chest, barbiturate-anesthetized dogs were instrumented for measurement of aortic and left ventricular (LV) pressure (micromanometer-tipped catheter), dP/dtmax, and LV volume (conductance catheter). Myocardial contractility was assessed with the end-systolic pressure-volume relation (Ees) and preload recruitable stroke work (Msw) generated from a series of LV pressure-volume diagrams. Left ventricular-arterial coupling and mechanical efficiency were determined by the ratio of Ees to effective arterial elastance (Ea; the ratio of end-systolic arterial pressure to stroke volume) and the ratio of stroke work (SW) to pressure-volume area (PVA), respectively. RESULTS: Desflurane, sevoflurane, and isoflurane reduced heart rate, mean arterial pressure, and left ventricular systolic pressure. All three anesthetics caused similar decreases in myocardial contractility and left ventricular afterload, as indicated by reductions in Ees, Msw, and dP/dtmax and Ea, respectively. Despite causing simultaneous declines in Ees and Ea, desflurane decreased Ees/Ea (1.02 +/- 0.16 during control to 0.62 +/- 0.14 at 1.2 minimum alveolar concentration) and SW/PVA (0.51 +/- 0.04 during control to 0.43 +/- 0.05 at 1.2 minimum alveolar concentration). Similar results were observed with sevoflurane and isoflurane. CONCLUSIONS: The present findings indicate that volatile anesthetics preserve optimum left ventricular-arterial coupling and efficiency at low anesthetic concentrations (< 0.9 minimum alveolar concentration); however, mechanical matching of energy transfer from the left ventricle to the arterial circulation degenerates at higher end-tidal concentrations. These detrimental alterations in left ventricular-arterial coupling produced by desflurane, sevoflurane, and isoflurane contribute to reductions in overall cardiac performance observed with these agents in vivo.
Authors:
D A Hettrick; P S Pagel; D C Warltier
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Anesthesiology     Volume:  85     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-09-12     Completed Date:  1996-09-12     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  403-13     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226, USA.
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MeSH Terms
Descriptor/Qualifier:
Anesthesia
Anesthetics, Inhalation / toxicity*
Animals
Aorta / drug effects*,  physiology
Barbiturates
Blood Pressure / drug effects
Depression, Chemical
Dogs
Ethers / toxicity
Female
Heart Rate / drug effects
Isoflurane / analogs & derivatives,  toxicity
Male
Methyl Ethers*
Myocardial Contraction / drug effects
Stroke Volume / drug effects
Ventricular Function, Left / drug effects*,  physiology
Ventricular Pressure / drug effects
Grant Support
ID/Acronym/Agency:
GM 08377/GM/NIGMS NIH HHS; HL 54820/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Barbiturates; 0/Ethers; 0/Methyl Ethers; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 57041-67-5/desflurane

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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