Document Detail

Sevoflurane speeds recovery of baroreflex control of heart rate after minor surgical procedures compared with isoflurane.
MedLine Citation:
PMID:  10439731     Owner:  NLM     Status:  MEDLINE    
Volatile anesthetics attenuate arterial baroreflex functions, whereas noxious stimuli may modify baroreflex-induced circulatory responses during anesthesia. We designed the present study to compare baroreflex control of heart rate during sevoflurane and isoflurane anesthesia in young healthy surgical patients. Baroreflex sensitivity was assessed in 24 patients randomized to receive either sevoflurane (n = 12) or isoflurane (n = 12) for general anesthesia. After an 8- to 10-h fast and no premedication, measurements of RR intervals obtained from electrocardiography and systolic blood pressure (SBP) measured through a radial artery catheter were made at conscious baseline (Awake), during end-tidal sevoflurane 2% or isoflurane 1.2% plus 67% nitrous oxide before incision (Anesth), during surgery at end-tidal sevoflurane 2% or isoflurane 1.2% plus 67% nitrous oxide (Surg), and 20 min after tracheal extubation (Recov). Baroreflex responses were triggered by bolus i.v. injections of phenylephrine (100-150 micrograms) and nitroprusside (100-150 micrograms) to increase and decrease SBP by 15-30 mm Hg, respectively. The linear portions of the baroreflex curves relating RR intervals and SBP were determined to obtain baroreflex sensitivities. Baroreflex sensitivities to both pressor and depressor tests were significantly depressed during Anesth and Surg periods compared with Awake values in both anesthetic techniques. The pressor test sensitivity during the Recov period returned to the Awake value after sevoflurane (12.9 +/- 3.7 vs 11.0 +/- 8.7 ms/mm Hg [mean +/- SD]) but was still depressed after isoflurane anesthesia (13.9 +/- 8.0 vs 4.8 +/- 3.2 ms/mm Hg; P < 0.05). The depressor test sensitivities during the Recov period remained depressed after both anesthetic techniques. We conclude that both sevoflurane and isoflurane depress arterial baroreflex function during anesthesia and surgery, but the pressor test sensitivity was restored more quickly after sevoflurane than after isoflurane anesthesia. Implications: Arterial baroreflex function is an important neural control system for maintaining cardiovascular stability. We found that baroreflex control of heart rate due to hypertensive perturbation returned to the preanesthetic level more quickly after sevoflurane than after isoflurane anesthesia.
M Tanaka; T Nishikawa
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  89     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-08-24     Completed Date:  1999-08-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  284-9     Citation Subset:  AIM; IM    
Department of Anesthesia, Akita University School of Medicine, Japan.
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MeSH Terms
Anesthesia Recovery Period
Anesthesia, General
Anesthetics, Inhalation / pharmacology*
Baroreflex / drug effects*,  physiology
Blood Pressure / drug effects
Heart Rate / drug effects*,  physiology
Isoflurane / pharmacology*
Methyl Ethers / pharmacology*
Nitroprusside / pharmacology
Phenylephrine / pharmacology
Surgical Procedures, Minimally Invasive*
Vasoconstrictor Agents / pharmacology
Vasodilator Agents / pharmacology
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Methyl Ethers; 0/Vasoconstrictor Agents; 0/Vasodilator Agents; 15078-28-1/Nitroprusside; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 59-42-7/Phenylephrine

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