Direct effects of volatile anesthetics on cardiac functiona

Abstract

The volatile anesthetics are a class of general anesthetic drugs used by the perfusionist during cardiopulmonary bypass (CPB). These agents are used in low doses in combination with other anesthetics to produce complete anesthesia. During CPB, these agents are capable of safely anesthetizing the paitent. It is well understood that these anesthetics act at the level of the central nervous system. However the intent of this study was to define the effects of isoflurane and sevoflurane on left ventricular function. C57BL/6 female mice were anesthetized with either isoflurane or sevoflurane at concentrations ranging from 0.5 to 5%. The cardiac function was assessed with transthoracic echocardiography (TTE). Sevoflurane caused a reduction of left ventricular function at lower concentrations compared with isoflurane. At concentrations of 2% and greater, sevoflurane significantly reduced cardiac output, ejection fraction, fractional shortening, and increased end-diastolic and end-systolic volumes. Isoflurane-induced reduction of left ventricular function was much less in magnitude when compared with sevoflurane. These data underscore the importance of using lower concentrations of volatile anesthetics during CPB especially during periods of cardiac recovery after aortic cross-clamp removal.

Keywords

ECHO mice volatile anesthetics cardiac function

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References

1 Stevens WC Cromwell TH Halsey MJ Eger EI Shakespeare TF Bahlman SH . The cardiovascular effects of a new inhalation anesthetic, Forane, in human volunteers at constant arterial carbon dioxide tension. Anesthesiology 1971; 35: 8–16.

2 Kazama T Ikeda K . The comparative effects of sevoflurane with halothane and isoflurane. J Anesth 1988; 2: 63–68.

3 Malan TP DiNardo JA Isner RJ . Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology 1995; 83: 918–928.

4 Personal communication from Daniel Redford. MD, University Medical Center, Tucson, Arizona.

5 Gonsowski CT Laster MJ Eger EI Ferrell LD Kerschmann RL . Toxicity of compound A in rats. Effect of increasing duration of administration. Anesthesiology 1994; 80: 566–573.

6 Hanaki C Fujii K Morio M Tashima T . Decomposition of sevoflurane by soda lime. Hiroshima J Med Sci 1987; 36: 61–62.

7 Davidkova TI Fujii K Kikuchi H . Urinary excretion of inorganic and organic fluoride after inhalation of sevoflurane. Hiroshima J Med Sci 1987; 36: 99–104.

8 De Hert SG Turani F Mathur S Stowe DF . Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg 2005; 100: 1584–1593.

9 Kashimoto S Oguchi T Kume M Manabe M Kumazawa T . Effects of sevoflurane on myocardial metabolism during postischemic reperfusion in the rat. J Anesth 1989; 3: 23–26.

10.

10 Cook TL Beppu WJ Hitt BA Kosek JC Mazze RI . A comparison of renal effects and metabolism of sevoflurane and methoxyflurane in enzyme-induced rats. Anesth Analg 1975; 54: 829–835.

11.

11 Slogoff S Keats AS Dear WE Abadia A Lawyer JT Moulds JP . Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetic agents in humans. Anesth Analg 1991; 72: 22–27.

12.

12 Forrest JB Cahalan MK Rehder K . Multicenter study of general anesthesia. II. Results. Anesthesiology 1990; 72: 262–268.

13.

13 Hess W Arnold B Schulte-Sasse U Tarnow J . Comparison of isoflurane and halothane when used to control intraoperative hypertension in patients undergoing coronary artery bypass surgery. Anesth Analg 1983; 62: 15–20.

14.

14 Moffitt EA Barker RA Glenn JJ . Myocardial metabolism and hemodynamic responses with isoflurane anesthesia for coronary artery surgery. Anesth Analg 1986; 65: 53–61.

15.

15 Eger EI Eisenkraft JB Weiskopf RB . The Pharmacology of Inhaled Anesthetics. 2nd edition, 2002.