Document Detail


Does anesthetic technique make a difference? Augmentation of systolic blood pressure during carotid endarterectomy: effects of phenylephrine versus light anesthesia and of isoflurane versus halothane on the incidence of myocardial ischemia.
MedLine Citation:
PMID:  3195756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Whether anesthetic technique affected the incidence of myocardial ischemia in 60 patients undergoing carotid endarterectomy was investigated. The patients were randomly assigned to receive halothane or isoflurane (with nitrous oxide) either at a low concentration alone or at a higher concentration with phenylephrine added to support blood pressure. Blood pressure was maintained within 20% of each patient's average ward systolic pressure. Seven leads of electrocardiograms (ECG) and echocardiograms were analyzed for segmental wall motion. The echocardiograms were analyzed using standard formulae for end-systolic meridional wall stress (SWS) and rate-corrected velocity of fiber shortening (Vcfc). Because of the nature of these calculations, only echocardiograms with normal regional wall motion could be accurately analyzed. The patients had postoperative ECG and creatinine phosphokinase (CPK) isoenzyme determinations and regularly scheduled clinical examinations to detect perioperative myocardial infarction and neurologic deficits. Although blood pressures were similar, the patients who received a higher concentration of anesthetic plus phenylephrine had a higher wall stress, regardless of the choice of anesthetic agent. All four techniques allowed provision of the same stump pressures (the marker surgeons used for adequacy of collateral carotid flow). No difference could be found in wall stress or incidence of myocardial ischemia between isoflurane and halothane. The patients who received phenylephrine had a threefold greater incidence of myocardial ischemia than did the patients who had light anesthesia to maintain similar systolic blood pressures and stump pressures. The groups were demographically and hemodynamically similar; in particular, the heart rates were not different.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
J S Smith; M F Roizen; M K Cahalan; D J Benefiel; P N Beaupre; Y J Sohn; B F Byrd; N B Schiller; R J Stoney; W K Ehrenfeld
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Anesthesiology     Volume:  69     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1988 Dec 
Date Detail:
Created Date:  1989-01-05     Completed Date:  1989-01-05     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  846-53     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia / methods*
Blood Pressure
Carotid Artery Diseases / surgery*
Cerebrovascular Circulation
Coronary Disease / chemically induced*
Electrocardiography
Endarterectomy*
Female
Halothane*
Humans
Isoflurane*
Male
Myocardial Contraction
Phenylephrine*
Prospective Studies
Random Allocation
Grant Support
ID/Acronym/Agency:
AGO 3104-04-06/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
151-67-7/Halothane; 26675-46-7/Isoflurane; 59-42-7/Phenylephrine
Comments/Corrections
Comment In:
Anesthesiology. 1989 Sep;71(3):465-8   [PMID:  2774280 ]

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


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