Crystal George J
Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL.
J Anesth Hist. 2017 Apr;3(2):56-62. doi: 10.1016/j.janh.2017.04.002. Epub 2017 Apr 12.
Isoflurane was introduced for general clinical use in North America in 1981. Shortly thereafter, in 1983, a study suggested that the anesthetic was a potent coronary vasodilator that could cause coronary steal and myocardial ischemia in patients with coronary artery disease. Myocardial ischemia results from small-vessel dilation which leads to increased blood flow to well-perfused myocardium and decreased blood flow to myocardium with borderline perfusion. This action of isoflurane raised concerns and threatened its use. By the early 1990s, these concerns were resolved by carefully performed clinical and experimental studies demonstrating no evidence of adverse cardiac changes during isoflurane administration as long as hemodynamic variables were tightly controlled. Indeed, the controversy sparked by the 1983 study led to a chain of experimental studies that ultimately demonstrated ironically that isoflurane has a preconditioning, cardioprotective effect. This chapter in anesthesia history underscores the importance of allowing the passage of time before assessing the clinical and scientific impact of a research finding.
异氟烷于1981年在北美被引入用于一般临床麻醉。此后不久，在1983年，一项研究表明，这种麻醉剂是一种强效冠状动脉血管扩张剂，可导致冠状动脉窃血和冠心病患者的心肌缺血。心肌缺血是由小血管扩张引起的，这会导致灌注良好的心肌血流量增加，而灌注临界的心肌血流量减少。异氟烷的这种作用引发了人们的担忧，并威胁到其使用。到20世纪90年代初，通过精心进行的临床和实验研究解决了这些担忧，这些研究表明，只要严格控制血流动力学变量，在使用异氟烷期间就没有不良心脏变化的证据。事实上，1983年的研究所引发的争议导致了一系列实验研究，最终具有讽刺意味的是，这些研究表明异氟烷具有预处理心脏保护作用。麻醉史上的这一章节强调了在评估研究发现的临床和科学影响之前留出时间的重要性。
