Goh R, Kitahata H
Department of Anesthesiology, Tokushima University School of Medicine.
Masui. 1991 Feb;40(2):224-36.
The effects of sevoflurane (Sev), isoflurane (Iso), and halothane (Hal) on coronary circulation were studied in 30 dogs with acute coronary arterial stenosis. Regional myocardial blood flow (rMBF) was measured by hydrogen clearance method. There was no significant difference between each anesthetic agent in heart rate, mean arterial pressure, and cardiac output under any anesthesia level. As the inspired concentration of each anesthetic is increased, rMBF decreased significantly and rMBF/rate-pressure-product (RPP) ratio increased in normal area. In Sev and Iso groups, rMBF/RPP ratios were higher than that in Hal group, suggesting luxury perfusion caused by Sev and Iso. In the ischemic area, rMBF was reduced depending on the inspired concentration of each anesthetic agent and transmural maldistribution of blood flow was not observed with any anesthetic agent. Nevertheless the ratio of rMBF in ischemic area to that of normal area was decreased in Sev and Iso groups, but not in Hal group. In this study, neither Sev nor Iso worsened regional myocardial ischemia. However, Sev-induced coronary vasodilation may cause regional myocardial ischemia by redistribution of flow under steal prone condition.
在30只患有急性冠状动脉狭窄的犬中研究了七氟醚(Sev)、异氟醚(Iso)和氟烷(Hal)对冠状动脉循环的影响。采用氢清除法测量局部心肌血流量(rMBF)。在任何麻醉水平下,各麻醉剂在心率、平均动脉压和心输出量方面均无显著差异。随着每种麻醉剂吸入浓度的增加,正常区域的rMBF显著降低,rMBF/心率-血压乘积(RPP)比值升高。在七氟醚和异氟醚组中,rMBF/RPP比值高于氟烷组,提示七氟醚和异氟醚导致了过度灌注。在缺血区域,rMBF根据每种麻醉剂的吸入浓度而降低,且未观察到任何麻醉剂导致的血流跨壁分布不均。然而,七氟醚和异氟醚组缺血区域的rMBF与正常区域的rMBF之比降低,而氟烷组未降低。在本研究中,七氟醚和异氟醚均未加重局部心肌缺血。然而,七氟醚诱导的冠状动脉血管舒张可能在易发生窃血的情况下通过血流重新分布导致局部心肌缺血。