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Anesth Analg 2006;103:350-358
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000222469.94134.ba

ANESTHETIC PHARMACOLOGY

Isoflurane Inhibits Compensatory Intravascular Volume Expansion After Hemorrhage in Sheep

Robert G. Hahn, MD, PhD*, Lance Brauer, MD{dagger}, Peter Rodhe*, Christer H. Svensén, MD, PhD{ddagger}, and Donald S. Prough, MD§

From the *Karolinska Institute, Stockholm, Sweden; {dagger}Anesthesia Investigational Intensive Care Unit, {ddagger}Department of Anesthesiology, §Professor and Rebecca Terry White Distinguished Chair of Anesthesiology, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas.

Address correspondence to Robert G. Hahn, MD, PhD, Department of Anesthesiology, Karolinska Institute at Soder Hospital, 118 83 Stockholm, Sweden. Address e-mail to robert.hahn{at}sodersjukhuset.se.

After hemorrhage, blood volume is partially restored by transcapillary refill, a process of spontaneous compensatory intravascular volume expansion that we hypothesized would be inhibited by anesthesia. Six chronically instrumented sheep were subjected to four randomly ordered experiments while conscious or during anesthesia with isoflurane. After plasma volume measurement (indocyanine green), 15% or 45% of the blood volume was withdrawn. To quantify transcapillary refill, mass balance and kinetic calculations utilized repeated measurements of hemoglobin concentration, assuming that transcapillary refill would dilute hemoglobin concentration. After 15% hemorrhage, mean arterial blood pressure remained stable in both conscious and isoflurane-anesthetized sheep (normotensive hemorrhage) but decreased after 45% hemorrhage (hypotensive hemorrhage). After either normotensive or hypotensive hemorrhage, transcapillary refill occurred more rapidly during the first 40 min than during the next 140 min (P < 0.001). In conscious sheep, at 180 min, 57% and 42% of the bled volume had been restored after normotensive and hypotensive hemorrhage, respectively, in contrast to only 13% and 27% (P < 0.001) in isoflurane-anesthetized sheep. A novel kinetic model implicated hemodynamic factors in rapid, early transcapillary refill and decreased plasma oncotic pressure in subsequent slower filling. We conclude that isoflurane inhibits transcapillary refill after both normotensive and hypotensive hemorrhage in sheep.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.