Document Detail


General anesthesia with sevoflurane decreases myocardial blood volume and hyperemic blood flow in healthy humans.
MedLine Citation:
PMID:  23385053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Preservation of myocardial perfusion during general anesthesia is likely important in patients at risk for perioperative cardiac complications. Data related to the influence of general anesthesia on the normal myocardial circulation are limited. In this study, we investigated myocardial microcirculatory responses to pharmacological vasodilation and sympathetic stimulation during general anesthesia with sevoflurane in healthy humans immediately before surgical stimulation.
METHODS: Six female and 7 male subjects (mean age 43 years, range 28-61) were studied at baseline while awake and during the administration of 1 minimum alveolar concentration sevoflurane. Using myocardial contrast echocardiography, myocardial blood flow (MBF) and microcirculatory variables were assessed at rest, during adenosine-induced hyperemia, and after cold pressor test-induced sympathetic stimulation. MBF was calculated from the relative myocardial blood volume multiplied by its exchange frequency (β) divided by myocardial tissue density (ρT), which was set at 1.05 g·mL(-1).
RESULTS: During sevoflurane anesthesia, MBF at rest was similar to baseline values (1.05 ± 0.28 vs 1.05 ± 0.32 mL·min(-1)·g(-1); P = 0.98; 95% confidence interval [CI], -0.18 to 0.18). Myocardial blood volume decreased (P = 0.0044; 95% CI, 0.01-0.04) while its exchange frequency (β) increased under sevoflurane anesthesia when compared with baseline. In contrast, hyperemic MBF was reduced during anesthesia compared with baseline (2.25 ± 0.5 vs 3.53 ± 0.7 mL·min(-1)·g(-1); P = 0.0003; 95% CI, 0.72-1.84). Sympathetic stimulation during sevoflurane anesthesia resulted in a similar MBF compared to baseline (1.53 ± 0.53 and 1.55 ± 0.49 mL·min(-1)·g(-1); P = 0.74; 95% CI, -0.47 to 0.35).
CONCLUSIONS: In otherwise healthy subjects who are not subjected to surgical stimulation, MBF at rest and after sympathetic stimulation is preserved during sevoflurane anesthesia despite a decrease in myocardial blood volume. However, sevoflurane anesthesia reduces hyperemic MBF, and thus MBF reserve, in these subjects.
Authors:
Carolien S E Bulte; Jeroen Slikkerveer; Otto Kamp; Martijn W Heymans; Stephan A Loer; Stefano F de Marchi; Rolf Vogel; Christa Boer; R Arthur Bouwman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-02-05
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  116     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-22     Completed Date:  2013-05-08     Revised Date:  2013-10-21    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  767-74     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 The Netherlands. c.bulte@vumc.n
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms
Anesthesia, General*
Anesthetics, Inhalation*
Blood Volume / drug effects*
Catecholamines / blood
Cold Temperature
Coronary Circulation / drug effects*
Data Interpretation, Statistical
Echocardiography / methods
Female
Heart / drug effects*
Humans
Hyperemia / physiopathology*
Male
Methyl Ethers*
Microcirculation / drug effects
Middle Aged
Muscle, Smooth, Vascular / drug effects
Pressure
Vasodilation / drug effects
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Catecholamines; 0/Methyl Ethers; 28523-86-6/sevoflurane
Comments/Corrections
Comment In:
Anesth Analg. 2013 Sep;117(3):745   [PMID:  23966649 ]
Anesth Analg. 2013 Sep;117(3):746   [PMID:  24143835 ]

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