Inoue K, Reichelt W, el-Banayosy A, Minami K, Dallmann G, Hartmann N, Windeler J
Department of Anesthesiology, Heart Center Nordrhein-Westfalen, Bad Oeynhausen, Federal Republic of Germany.
Anesth Analg. 1990 Nov;71(5):469-74. doi: 10.1213/00000539-199011000-00003.
To examine if the choice of volatile agents influences cardiac outcome in coronary artery surgery, 1178 patients undergoing elective coronary artery bypass grafting without additional operations received enflurane (608) or isoflurane (570) as their primary anesthetics. The inspired concentration of volatile agent (administered with 50% nitrous oxide) was adjusted depending on the level of blood pressure at the discretion of the anesthesiologist. In addition to the volatile agent assigned, each patient received small doses of fentanyl at induction and before sternotomy (total 0.006-0.008 mg/kg). The groups did not differ in preoperative and surgical characteristics except for a more frequent history of renal dysfunction in patients given isoflurane. The rates of postoperative myocardial infarction, administration of positive inotropic agents at the time of weaning from cardiopulmonary bypass, and in-hospital deaths in the enflurane and isoflurane groups were 1.8% and 4.0% (P less than 0.05), 4.9% and 8.1% (P less than 0.05%), and 0.3% and 2.1% (P less than 0.01), respectively. Although the mechanism of the adverse effects of isoflurane could not be clarified in this study, these results demonstrate that the use of isoflurane could be inappropriate in patients undergoing coronary artery bypass grafting.
为研究挥发性麻醉剂的选择是否会影响冠状动脉手术的心脏预后，1178例接受择期冠状动脉搭桥术且无其他附加手术的患者分别接受恩氟烷（608例）或异氟烷（570例）作为主要麻醉剂。挥发性麻醉剂的吸入浓度（与50%氧化亚氮合用）由麻醉医生根据血压水平酌情调整。除了分配的挥发性麻醉剂外，每位患者在诱导期和胸骨切开术前均接受小剂量芬太尼（总量0.006 - 0.008mg/kg）。除了接受异氟烷的患者肾功能不全病史更常见外，两组患者的术前和手术特征无差异。恩氟烷组和异氟烷组术后心肌梗死发生率、体外循环撤机时使用正性肌力药物的比例以及住院死亡率分别为1.8%和4.0%（P<0.05）、4.9%和8.1%（P<0.05）以及0.3%和2.1%（P<0.01）。尽管本研究中异氟烷不良反应的机制尚不清楚，但这些结果表明，在接受冠状动脉搭桥术的患者中使用异氟烷可能不合适。
