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February 1997
Cardiovascular effects of desflurane and isoflurane in patients with coronary artery disease
Grundmann U, M�ller M, Kleinschmidt S, Larsen B, Larsen R;
Acta Anesthesiol Scand,1996;40:1101-1107
[ see abstract below ]
This study compares the cardiovascular effects of equipotent concentrations of desflurane and isoflurane in ASA 3 patients undergoing elective CABG surgery. Both groups had a standardized induction with etomidate and 3-5 mcg/kg fentanyl and pancuronium. The inhaled agent was administered in slowly increasing concentrations after intubation.
Patients who received beta blockers were excluded from the study. Both groups showed a significant but similar decrease in mean arterial pressure and systemic vascular resistance with increasing anesthetic depth. There were however differing pulmonary capillary wedge pressure results. Patients who received isoflurane had no change in PCWP, but the patients with desflurane had significant increases in pressures starting at 0.5 MAC.
Also, pulmonary artery pressure increased with increasing inhalant depth only with desflurane, while there was no change with isoflurane. The authors, therefore, recommend caution for the use of desflurane as an alternative anesthetic in patients with ischaemic heart disease.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Background: Anaesthesia in patients with ischaemic heart disease may cause adverse haemodynamic reactions. This investigation compares the cardiovascular effects of equipotent concentrations of desflurane and isoflurane in 30 patients (ASA III) with coronary artery disease before surgical stimulation.
Methods: After standardised induction of anaesthesia with etomidate, fentanyl and pancuronium and tracheal intubation patients randomly received either desflurane (group I, n=15) or isoflurane (group II, n=15) in slowly increasing concentrations. ST-segment analysis and haemodynamic measurements were performed at 0.25, 0.5, 0.75 and 1.0 MAC of desflurane or isoflurane.
Results: Cardiac index did not change significantly in the two groups during the administration of the inhalational anaesthetics. Desflurane and isoflurane both caused a dose-dependent significant decrease of mean arterial blood pressure (group I:-16%; group II: -18%). As with isoflurane, the decrease of mean arterial blood pressure produced by desflurane primarily resulted from a decrease in systemic vascular resistance (group I: -26%; group II: -21%).
Central venous pressure was not affected by the two volatile anaesthetics. Pulmonary artery pressure and pulmonary capillary wedge pressure remained unchanged during the administration of isoflurane, but in contrast both parameters significantly increased in patients receiving desflurane (PAP 24%, PCWP 40%). ST-segment analysis provided no signs of myocardial ischaemia.
Conclusions: The results of this study demonstrate that in patients with coronary artery disease the haemodynamic effect of equipotent concentrations of desflurane and isoflurane are similar except for a significant increase in PAP and PCWP caused by desflurane. Therefore, desflurane should be administered with great caution if it is used as an alternative anaesthetic in patients with ischaemic heart disease.
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