Document Detail


Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?
MedLine Citation:
PMID:  10456814     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension. METHODS: In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 microg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (to)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 31/ min. RESULTS: Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end-systolic wall-stress (ESWS) and left-ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post-induction values with mean end-tidal concentration of 5.1+/-0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end-diastolic and end-systolic cross-sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. CONCLUSION: This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major cardiac depressant effect.
Authors:
D Eyraud; F Benmalek; K Teugels; M Bertrand; S Mouren; P Coriat
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  43     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-30     Completed Date:  1999-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  737-43     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care, Hôpital de la Pitié-Salpêtrière, Paris VI University, France.
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Inhalation / administration & dosage*
Anesthetics, Intravenous / administration & dosage
Aorta / surgery*
Atracurium / administration & dosage
Blood Pressure / physiology
Cardiac Output / drug effects
Catheterization, Swan-Ganz
Diastole
Echocardiography, Transesophageal
Female
Heart Rate / drug effects
Heart Ventricles / drug effects
Humans
Hypertension / prevention & control*
Intraoperative Complications / prevention & control*
Intubation, Intratracheal
Isoflurane / administration & dosage,  analogs & derivatives*
Male
Midazolam / administration & dosage
Middle Aged
Neuromuscular Nondepolarizing Agents / administration & dosage
Nitrous Oxide / administration & dosage
Oxygen / administration & dosage
Stroke Volume / drug effects
Sufentanil / administration & dosage
Systole
Vascular Resistance / drug effects
Ventricular Function, Left / drug effects*
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Neuromuscular Nondepolarizing Agents; 10024-97-2/Nitrous Oxide; 26675-46-7/Isoflurane; 56030-54-7/Sufentanil; 57041-67-5/desflurane; 59467-70-8/Midazolam; 64228-79-1/Atracurium; 7782-44-7/Oxygen

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


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