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Anesth Analg 1986; 65:53-61
© 1986 International Anesthesia Research Society
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Myocardial Metabolism and Hemodynamic Responses with Isoflurane Anesthesia for Coronary Arterial Surgery

Emerson A. Moffitt, MD, Richard A. Barker, MB, John J. Glenn, MB, David D. Imrie, MB, Carlos DelCampo, MD, Rodney W. Landymore, MD, C. Edwin Kinley, MD, and David A. Murphy, MD

Received from the Department of Anaesthesia and Division of Cardiovascular Surgery, Dalhousie University and the Maritime Heart Centre, Victoria General Hospital, Halifax, Nova Scotia, Canada.

Abstract

Isoflurane-oxygen was given for induction and maintenance of anesthesia to ten patients having coronary artery bypass grafts. All had preserved ventricular function without hypertension or other cardiac lesions; treatment with ß-blocking drugs was maintained until the operation in all patients. Cardiac output, arterial and central pressures, coronary sinus (CS) blood flow, arterial and CS oxygen, Hb, and lactate contents were measured before, six times during, and twice after anesthesia. On induction, systolic arterial pressure was purposely reduced 33% along with systemic resistance by increasing the concentration of isoflurane; cardiac index, heart rate, and coronary flow did not change. Coronary resistance decreased 23% and CS oxygen content increased 56% but in three of ten patients myocardial lactate production took place, evidence of global ischemia. Induction of anesthesia was not smooth in three patients. Controlled hemodynamic depression could be maintained with isoflurane-oxygen, but the frequency of myocardial lactate production before and after perfusion was greater than with other general anesthetics. Isoflurane dilated portions of the coronary bed but, because anaerobic metabolism occurred concomitantly, the theory that redistribution of flow can take place resulting in ischemic areas of ventricle is supported.

Key Words: ANESTHETICS, VOLATILE—isoflurane • SURGERY, CARDIOVASCULAR




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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 © 1986 by the International Anesthesia Research Society.