THE HEMODYNAMIC AND RENAL EFFECTS OF SEVOFLURANE AND ISOFLURANE IN PATIENTS WITH CORONARY-ARTERY DISEASE AND CHRONIC HYPERTENSION

In patients without significant cardiovascular disease, the hemodynami c effects of sevoflurane and isoflurane are similar; however, the hemo dynamic effects of sevoflurane in patients with hypertension and ische mic heart disease are unknown. To examine the effects of sevoflurane i n comparison to isoflurane in this highrisk population, 214 patients s cheduled for elective surgery were enrolled if they had evidence of is chemic heart disease or multiple risk factors for ischemic heart disea se. Patients were randomly assigned to receive sevoflurane (n = 106) o r isoflurane (n = 108) for anesthetic maintenance in conjunction with fentanyl and nitrous oxide in oxygen. Deviations in arterial blood pre ssure or heart rate of more than 20% from preinduction values that per sisted after adjustment of the Volatile anesthetic concentration were treated with intravenous phenylephrine, ephedrine, nitroglycerin, atro pine, or esmolol as needed. Creatinine, blood urea nitrogen (BUN), and urine protein were measured before surgery, immediately after surgery , and 24 and 48 h postoperatively. For analysis, patients were divided into those with and those without the diagnosis of chronic hypertensi on. Heart rate and arterial blood pressure responses to sevoflurane an d isoflurane were not different for the patients with or without chron ic hypertension. Neither anesthetic was associated with a more frequen t treatment for hemodynamic deviation. After surgery, creatinine and B UN decreased in both the sevoflurane and isoflurane groups without sig nificant differences between groups. The incidence of postoperative pr oteinuria was similar in the sevoflurane and isoflurane groups. We con clude that hemodynamic stability in patients with hypertension and isc hemic heart disease is similar with sevoflurane and isoflurane. No dif ferences in renal function were observed between the sevoflurane and i soflurane groups.