Ebert T J, Harkin C P, Muzi M
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
Anesth Analg. 1995 Dec;81(6 Suppl):S11-22. doi: 10.1097/00000539-199512001-00003.
In conclusion, sevoflurane appears to be similar to isoflurane and desflurane with a few exceptions. Sevoflurane was not associated with increases in heart rate in adult patients and volunteers, whereas higher MACs of isoflurane and desflurane and rapid increases in the inspired concentrations of these two anesthetics have been associated with tachycardia. Increasing concentrations of sevoflurane progressively decrease blood pressure in a manner similar to the other volatile anesthetics, and in unstimulated volunteers this decrease may be slightly less than with isoflurane at a higher MAC. Sevoflurane appears similar to isoflurane in its effect on regional blood flows, including the hepatic, renal, and cerebral circulation. In animals, sevoflurane appears to be a slightly less potent coronary vasodilator than isoflurane, and in a dog model, sevoflurane has not been associated with coronary flow redistribution ("steal"). Sevoflurane decreases myocardial contractility in a manner similar to equianesthetic concentrations of isoflurane and desflurane, and does not potentiate epinephrine-induced cardiac arrhythmias. Sevoflurane reduces baroreflex function in a manner similar to other volatile anesthetics. In several multicenter studies where patients with CAD or patients at high risk for CAD were randomized to receive either sevoflurane or isoflurane for cardiac or noncardiac surgery, the incidence of myocardial ischemia, infarction, and cardiac outcomes did not differ between treatment groups. Thus, sevoflurane has not been associated with untoward cardiovascular changes in volunteers and patients undergoing elective surgery compared with other volatile anesthetics, and it appears to offer a more stable heart rate profile than either isoflurane or desflurane.
总之，七氟烷似乎与异氟烷和地氟烷相似，但有一些例外。七氟烷与成年患者和志愿者的心率增加无关，而异氟烷和地氟烷的较高最低肺泡有效浓度（MAC）以及这两种麻醉剂吸入浓度的快速增加与心动过速有关。七氟烷浓度的增加会以与其他挥发性麻醉剂类似的方式逐渐降低血压，在未受刺激的志愿者中，这种降低可能比在较高MAC时的异氟烷略小。七氟烷在对包括肝、肾和脑循环在内的局部血流的影响方面似乎与异氟烷相似。在动物中，七氟烷似乎是一种比异氟烷稍弱的冠状动脉血管扩张剂，并且在犬模型中，七氟烷与冠状动脉血流重新分布（“窃血”）无关。七氟烷以与等效麻醉浓度的异氟烷和地氟烷类似的方式降低心肌收缩力，并且不会增强肾上腺素诱导的心律失常。七氟烷以与其他挥发性麻醉剂类似的方式降低压力反射功能。在几项多中心研究中，将患有冠状动脉疾病（CAD）或有CAD高风险的患者随机分为接受七氟烷或异氟烷进行心脏或非心脏手术，治疗组之间心肌缺血、梗死和心脏结局的发生率没有差异。因此，与其他挥发性麻醉剂相比，七氟烷在接受择期手术的志愿者和患者中未出现不良心血管变化，并且它似乎提供了比异氟烷或地氟烷更稳定的心率情况。
