Preckel Benedikt, Obal Detlef, Müllenheim Jost, Hennes Juliane, Heiderhoff Marc, Thämer Volker, Schlack Wolfgang
Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Postbus 22660 H1Z-139, 1100 DD Amsterdam, The Netherlands.
Can J Anaesth. 2006 Nov;53(11):1118-25.
Frequency potentiation is the increase in force of contraction induced by an increased heart rate (HR). This positive staircase phenomenon has been attributed to changes in Ca2+ entry and loading of intracellular Ca2+ stores. Volatile anesthetics interfere with Ca2+ homeostasis of cardiomyocytes. We hypothesized that frequency potentiation is altered by volatile anesthetics and investigated the influence of halothane (H), sevoflurane (S) and desflurane (D) on the positive staircase phenomenon in dogs in vivo.
Dogs were chronically instrumented for measurement of left ventricular (LV) pressure and cardiac output. Heart rate was increased by atrial pacing from 120 to 220 beats x min(-1) and the LV maximal rate of pressure increase (dP/dt(max)) was determined as an index of myocardial performance. Measurements were performed in conscious dogs and during anesthesia with 1.0 minimal alveolar concentrations of each of the three inhaled anesthetics.
Increasing HR from 120 to 220 beats x min(-1) increased dP/dt(max) from 3394 +/- 786 (mean +/- SD) to 3798 +/- 810 mmHg sec(-1) in conscious dogs. All anesthetics reduced dP/dt(max) during baseline (at 120 beats x min(-1): H, 1745 +/- 340 mmHg x sec(-1); S, 1882 +/- 418; D, 1928 +/- 454, all P < 0.05 vs awake) but did not influence the frequency potentiation of dP/dt(max) (at 220 beats x min(-1): H, 1981 +/- 587 mmHg x sec(-1); S, 2187 +/- 787; D, 2307 +/- 691). The slope of the regression line correlating dP/dt(max) and HR was not different between awake and anesthetized dogs. Increasing HR did not influence cardiac output in awake or anesthetized dogs.
These results indicate that volatile anesthetics do not alter the force-frequency relation in dogs in vivo.
频率增强是指心率(HR)增加引起的收缩力增强。这种正阶梯现象归因于Ca2+内流的变化以及细胞内Ca2+储存的增加。挥发性麻醉药会干扰心肌细胞的Ca2+稳态。我们假设挥发性麻醉药会改变频率增强,并研究了氟烷(H)、七氟烷(S)和地氟烷(D)对犬体内正阶梯现象的影响。
对犬进行长期仪器植入以测量左心室(LV)压力和心输出量。通过心房起搏将心率从120次/分钟提高到220次/分钟,并将左心室最大压力上升速率(dP/dt(max))作为心肌性能指标进行测定。在清醒犬以及使用三种吸入麻醉药中每种药物的1.0最低肺泡浓度进行麻醉期间进行测量。
在清醒犬中,将心率从120次/分钟提高到220次/分钟,dP/dt(max)从3394±786(平均值±标准差)增加到3798±810 mmHg·sec(-1)。所有麻醉药在基线时(心率120次/分钟时:氟烷,1745±340 mmHg·sec(-1);七氟烷,1882±418;地氟烷,1928±454,与清醒状态相比所有P<0.05)均降低了dP/dt(max),但不影响dP/dt(max)的频率增强(心率220次/分钟时:氟烷,1981±587 mmHg·sec(-1);七氟烷,2187±787;地氟烷,2307±691)。清醒犬和麻醉犬中,dP/dt(max)与心率相关的回归线斜率无差异。心率增加对清醒或麻醉犬的心输出量无影响。
这些结果表明,挥发性麻醉药不会改变犬体内的力-频率关系。