Ohqvist G, Settergren G, Ekeström S, Brodin L A
Acta Anaesthesiol Scand. 1985 Nov;29(8):758-63. doi: 10.1111/j.1399-6576.1985.tb02296.x.
The effects of isoflurane on graft blood flow, central hemodynamics and ECG were evaluated in 20 patients during coronary artery surgery in the period immediately after cardiopulmonary bypass (CPB). Intravenous anesthesia with thiopentone, diazepam, fentanyl (continuous infusion), droperidol and pancuronium supplemented with nitrous oxide was used before, and thiopentone and fentanyl were used during CPB. A first measurement of graft flow was performed during fentanyl infusion and the patients were randomly allocated to a control (n = 10) and a study (n = 10) group. In the study group isoflurane was administered in a dose that reduced systolic arterial blood pressure (SAP) to approximately 100 mmHg (13.3 kPa) (inspired concentration 0.5-1.5%) and a second measurement was performed after 30 min. In the control group the infusion of fentanyl was continued. Isoflurane reduced graft blood flow from 52 +/- 5 (mean and s.e. mean) to 40 +/- 5 ml . min-1 (P less than 0.01) concomitant with reductions in SAP, cardiac index, stroke index, left ventricular stroke work index and power index, while these parameters as well as graft flow remained unchanged in the control group. Isoflurane did not produce any change in the degree of ischemia as judged from the ECG. A high blood flow in recently established coronary artery bypass grafts is essential for the prevention of early graft occlusion; therefore the graft-flow-reducing effect of isoflurane has to be taken into consideration when evaluating different anesthetic regimens in the period after CPB.
在20例冠状动脉手术患者体外循环（CPB）后即刻，评估异氟烷对移植血管血流量、中心血流动力学和心电图的影响。CPB前采用硫喷妥钠、地西泮、芬太尼（持续输注）、氟哌利多和泮库溴铵静脉麻醉并辅以氧化亚氮，CPB期间使用硫喷妥钠和芬太尼。在芬太尼输注期间首次测量移植血管血流量，并将患者随机分为对照组（n = 10）和研究组（n = 10）。研究组给予异氟烷，剂量为将收缩动脉压（SAP）降至约100 mmHg（13.3 kPa）（吸入浓度0.5 - 1.5%），30分钟后进行第二次测量。对照组继续输注芬太尼。异氟烷使移植血管血流量从52±5（均值和标准误均值）降至40±5 ml·min-1（P<0.01），同时SAP、心脏指数、每搏指数、左心室每搏功指数和功率指数均降低，而对照组这些参数以及移植血管血流量保持不变。根据心电图判断，异氟烷未引起缺血程度的任何变化。近期建立的冠状动脉旁路移植血管的高血流量对于预防早期移植血管闭塞至关重要；因此，在评估CPB后不同麻醉方案时，必须考虑异氟烷降低移植血管血流量的作用。
