CARDIOVASCULAR EFFECTS OF DESFLURANE AND ISOFLURANE IN PATIENTS WITH CORONARY-ARTERY DISEASE

Background: Anaesthesia in patients with ischaemic heart disease may c ause adverse haemodynamic reactions. This investigation compares the c ardiovascular effects of equipotent concentrations of desflurane and i soflurane in 30 patients (ASA III) with coronary artery disease before surgical stimulation. Methods: After standardised induction of anaest hesia with etomidate, fentanyl and pancuronium and tracheal intubation patients randomly received either desflurane (group I, n=15) or isofl urane (group Il, 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 di d not change significantly in the two groups during the administration of the inhalational anaesthetics. Desflurane and isoflurane both caus ed a dose-dependent significant decrease of mean arterial blood pressu re (group I: -16%; group II: -18%). As with isoflurane, the decrease o f mean arterial pressure produced by desflurane primarily resulted fro m a decrease in systemic vascular resistance (group I: -26%, group II: -21%). Central venous pressure was not affected by the two volatile a naesthetics. Pulmonary artery pressure and pulmonary capillary wedge p ressure remained unchanged during the administration of isoflurane, bu t in contrast both parameters significantly increased in patients rece iving desflurane (PAP 24%, PCWP 40%). ST-seg ment analysis provided no signs of myocardial ischaemia. Conclusion: The results of this study demonstrate that in patients with coronary artery disease the haemodyn amic effects 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.