Abstract
Purpose
To test the hypothesis that thiopentone, propofol, and etomidate alter the coronary vascular effects of abruptly administered isoflurane.
Methods
Dogs (n = 6) received inspired isoflurane 5% in the presence of thiopentone (20 mg·kg−1 induction dose and 20 mg·kg−1·hrt-1 infusion), propofol (5 mg·kg−1 induction dose and 40 mg·kg−1·hr−1 infusion), etomidate (2 mg·kg−1 induction dose and 5 mg·kg−1·hr−1 infusion), or isoflurane (1.0 MAC) anaesthesia in a random fashion. Haemodynamics were assessed in the conscious state, during baseline anaesthesia, and at 30 sec intervals for five minutes after beginning isoflurane 5%.
Results
Rapidly administered isoflurane caused greater (P < 0.05) reductions in coronary vascular resistance in thiopentoneor propofol-than in isoflurane-anaesthetized dogs. Isoflurane produced greater (P < 0.05) increases in the ratio of coronary blood flow velocity to pressure-work index (an index of myocardial oxygen consumption; +109 ± 19 % during isoflurane alonevs + 182 ± 27 % change from baseline during propofol and isoflurane) consistent with relatively greater direct coronary vasodilatation during baseline propofol than during baseline isoflurane anaesthesia. Isoflurane caused larger increases in coronary blood flow velocity in dogs anaesthetized with etomidate concomitant with higher coronary perfusion pressure and pressure-work index than in those anaesthetized with isoflurane alone.
Conclusions
The results suggest that thiopentone, propofol, and etomidate each uniquely modify the coronary vascular responses to abrupt administration of high inspired concentrations of isoflurane in chronically instrumented dogs.
Résumé
Objectif
Vérifier l’hypothèse qui veut que le thiopental, le propofol et l’étomidate modifient les effets vasculaires coronariens de l’administration rapide d’isoflurane.
Méthode
Des chiens (n = 6) ont reçu une anesthésie par inhalation d’isoflurane 5 % combiné au thiopental (20 mg·kg−1 comme dose d’induction et 20 mg·kg−1·hr−1 pour la perfusion), au propofol (5 mg·kg−1 à l’induction et 40 mg·kg−1 sdhr−1 à la perfusion), à l’étomidate (2 mg·kg−1 à l’induction et 5 mg·kg−1·hr−1 à la perfusion), ou à l’isoflurane (1,0 CAM) de façon aléatoire. Les paramètres hémodynamiques ont été évalués chez l’animal éveillé, pendant l’anesthésie de base et à intervalles de 30 s pendant cinq minutes après le début de l’isoflurane 5%.
Résultats
L’administration rapide d’isoflurane a causé des réductions plus importantes (P < 0,05) de résistance vasculaire coronarienne chez les chiens qui ont reçu du thiopental, ou du propofol, que chez ceux qui ont reçu une anesthésie avec l’isoflurane. L’isoflurane a produit un accroissement plus grand (P < 0,05) du rapport entre la vitesse du flux sanguin coronarien et l’index travail-pression (un index de la consommation d’oxygène par le myocarde; +109 ± 19 % pendant l’anesthésie avec l’isoflurane seul vs + 182 ± 27 % de changement par rapport à l’anesthésie de base avec l’emploi de propofol et d’isoflurane) concordant avec une vasodilatation coronarienne directe relativement plus grande pendant l’anesthésie de base au propofol que pendant l’anesthésie de base à l’isoflurane. Lisoflurane a provoqué des hausses plus marquées de la vitesse du flux sanguin coronarien chez les chiens anesthésiés avec l’étomidate, hausses qui étaient concomitantes à des pressions de perfusion coronarienne et à un index plus élevés que chez ceux qui ont reçu de l’isoflurane seulement.
Conclusion
Les résultats suggèrent que, selon ses caractéristiques propres, chacun des anesthésiques, thiopental, propofol et étomidate, modifient les réactions vasculaires coronariennes à l’administration rapide de grandes concentrations d’isoflurane inhalées par des chiens en monitorage prolongé.
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This work was supported by a grant from the Foundation for Anesthesia Education and Research (JRK), US PHS grants HL54820 (DCW) and HL03690 (JRK), and Anesthesiology Research Training Grant GM08377 (DCW).
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Pagel, P.S., Hettrick, D.A., Kersten, J.R. et al. Propofol, but not thiopentone or etomidate, enhances isoflurane-induced coronary vasodilatation in dogs. Can J Anaesth 45, 809–817 (1998). https://doi.org/10.1007/BF03012155
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DOI: https://doi.org/10.1007/BF03012155