Novalija E, Hogan Q H, Kulier A H, Turner L H, Bosnjak Z J
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
Acta Anaesthesiol Scand. 1998 Mar;42(3):353-7. doi: 10.1111/j.1399-6576.1998.tb04929.x.
Although desflurane (DES) and sevoflurane (SEV) have desirable features for use in patients with coronary artery disease, their effects on ventricular dysrhythmias following infarction are less known. We therefore examined the effects of DES and SEV upon spontaneous postinfarction ventricular dysrhythmias in dogs, and compared those effects to the well-established antidysrhythmic effects of halothane (HAL) in this model.
After institutional approval, the left anterior descending coronary artery was ligated in 16 adult mongrel dogs during isoflurane anesthesia. All dogs developed acute myocardial infarction and severe ventricular tachydysrhythmias. Twenty-two hours after infarction, dogs were anesthetized at 1.5 MAC with desflurane (10.8%) followed by sevoflurane (3.5%) in the treatment group (n = 10), or halothane (1.3%) in the other group (n = 6). Anesthetic gases were allowed to equilibrate for at least 20 min at each end-tidal concentration. At this time, the ECG was recorded for 9 min and evaluated for the number of ventricular ectopic and sinoatrial beats and summed duration of ventricular tachycardia.
DES and SEV reduced the average rate of total ventricular ectopic beats by 40 +/- 4% and 42 +/- 4%, respectively. HAL decreased total ventricular ectopic rate by 59 +/- 6% and 62 +/- 5% after durations of anesthesia comparable to DES and SEV, respectively. Decreases in dysrhythmia in the presence of DES and SEV were significantly smaller than those produced by HAL after a comparable total duration of anesthesia.
DES and SEV inhibit spontaneous postinfarction ventricular dysrhythmias, although attenuation of dysrhythmias was smaller than the inhibition during comparable doses of HAL.
尽管地氟烷（DES）和七氟烷（SEV）在冠状动脉疾病患者中使用具有理想的特性，但它们对梗死后室性心律失常的影响尚鲜为人知。因此，我们研究了DES和SEV对犬自发性梗死后室性心律失常的影响，并将这些影响与该模型中已确立的氟烷（HAL）抗心律失常作用进行比较。
经机构批准后，在异氟烷麻醉期间对16只成年杂种犬结扎左前降支冠状动脉。所有犬均发生急性心肌梗死和严重室性快速心律失常。梗死后22小时，治疗组（n = 10）的犬用1.5 MAC的地氟烷（10.8%）麻醉，随后用七氟烷（3.5%）麻醉，另一组（n = 6）用氟烷（1.3%）麻醉。每种呼气末浓度下，麻醉气体至少平衡20分钟。此时，记录心电图9分钟，并评估室性异位搏动和窦性搏动的数量以及室性心动过速的总持续时间。
DES和SEV分别使室性异位搏动的平均总发生率降低了40±4%和42±4%。在与DES和SEV相当的麻醉持续时间后，HAL分别使室性异位搏动总发生率降低了59±6%和62±5%。在麻醉总持续时间相当的情况下，DES和SEV存在时心律失常的降低明显小于HAL产生的降低。
DES和SEV可抑制自发性梗死后室性心律失常，尽管心律失常的减轻程度小于同等剂量HAL的抑制作用。
