A. Meissner et al., Recovery from myocardial stunning is faster with desflurane compared with propofol in chronically instrumented dogs, ANESTH ANAL, 91(6), 2000, pp. 1333-1338
Citations number
30
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Volatile anesthetics exert a protective role in myocardial ischemia. An inc
rease in sympathetic tone might exert deleterious effects on the ischemic m
yocardium. The use of the volatile anesthetic desflurane in myocardial isch
emia is controversial because of its sympathetic activation. We compared pr
opofol and desflurane on myocardial stunning in chronically instrumented do
gs. Mongrel dogs (n = 8) were chronically instrumented for measurement of h
eart rate, left atrial, aortic, and left ventricular pressure, rate of rise
of left ventricular pressure, and myocardial wall-thickening fraction (WTF
). An occluder around the left anterior descending artery (LAD) allowed the
induction of reversible LAD-ischemia. Two experiments were performed in a
crossover fashion on separate days: 1) Induction of 10 min of LAD-ischemia
during desflurane anesthesia and 2) Induction of 10 min of LAD-ischemia dur
ing propofol anesthesia. Both anesthetics were discontinued immediately aft
er completion of ischemia. WTF was measured at predetermined time points un
til complete recovery from ischemic dysfunction occurred. Both anesthetics
caused a significant decrease of WTF in the LAD-perfused myocardium. LAD-is
chemia led to a further significant decrease of LAD-WTF in both groups. Dur
ing the first 3 h of reperfusion, WTF was significantly larger in the desfl
urane group. Mean arterial pressure and heart rate were greater during isch
emia and the first 10 min of reperfusion in the desflurane group compared w
ith the propofol group. Recovery from myocardial stunning in dogs was faste
r when desflurane was used at the time of ischemia as compared with propofo
l anesthesia. The mechanism for this difference is unclear, but sympathetic
activation by desflurane was not a limiting factor for ischemic tolerance
in chronically instrumented dogs.