Abstract
Fifty patients with ischaemic heart disease scheduled for coronary artery bypass surgery received either an enflurane or a halothane anaesthetic. The anaesthetic techniques were randomly assigned to the patients and consisted of induction with diazepam 0.5 mg·kg-1 and pancuronium 0.1 mg·kg-1 supplemented by nitrous oxide and oxygen (50:50). Enflurane in dosages of 0.5–1.5 volumes per cent and halothane 0.3–0.7 volumes per cent were administered to Group E (25 patients) and Group H (25 patients), respectively. The inhalation drug dosage was varied to maintain heart rate and systemic blood pressure within predetermined limits.
The two patient groups (E and H) were compared with regard to myocardial damage (determined electrocardiographically and enzymatically) as well as by haemodynamic changes and adjuvant cardiovascular drug therapy. One patient in group H sustained a postoperative infarction detected by electrocardiogram and sustained CK MB release. There was no other unequivocal electrocardiographic evidence of myocardial infarction in either group and the myocardial damage estimated from CK MB curves was remarkably low and similar in both anaesthetic groups. Myocardial damage was estimated by CK MB maximum release (CK MB MAX) of 8.1 ± 1.00IU/1 (Group E), 7.8 ± 1.32IU/I (Group H), by area under the CK MB disappearance curve (CK MB AREA) of 144 ± 21.9 IU/1 x hr (Group E), 173 ± 32.9 IU/1 x hr (Group H), and by the accumulated CK MB or CK MB damage size (CK MB DS) of 10.S±1.79IU/1 (Group E), 10.3 ± 2.26 IU/1 (Group H). There was no release of CK MB before cardiopulmonary bypass in either group. There was no statistically significant difference between the two groups for myocardial damage, haemodynamics or adjuvant drug interventions. There was a trend toward greater use of vasodilators in Group H than in Group E.
It is concluded that enflurane and halothane are associated with equally low levels of myocardial damage when used for anaesthesia in patients with ischaemic heart disease. The release of CK MB occurred following cardiopulmonary bypass and probably represents imperfect myocardial preservation. Patients with severely impaired ventricular function were not studied, and in these patients enflurane and halothane must be used judiciously.
Résumé
Cinquante insuffisants coronariens opérés (pontages aorto-coronariens) ont reçu comme anesthésique principal de ľenflurane (groupe E: 25 cas) ou de ľhalothane (groupe H: 25 cas), la sélection de ľagent étant faite au hasard. A ľinduction de ľanesthésie, les patients recevaient par voie intraveineuse 0.5 mg·kg-1 de diazepam et 0.1 mg·kg-1 de pancuronium, puis on les ventilait avec un mélange de protoxyde ďazote et ďoxygène à 50 pour cent additionné selon le cas ďhalothane(0.3 à 0.7 pour cent) ou ďenflurane (0.5 à 1.5 pour cent). Les concentrations de ces agents étaient ajustées de façon à maintenir la fréquence cardiaque et la pression systolique à ľintérieur de limites prédéterminées. On a comparé chez les patients des deux groupes les dommages myocardiques (critères électrocardiographiques et enzymatiques), les modifications hémodynamiques et les besoins en médication vaso-active.
Un seul patient (du groupe H) a présenté un infarctus post-opératoire avec manifestations électrocardiographiques et enzymatiques. On n’a pas relevé ďautres manifestations claires ďinfarctus à ľélectrocardiogramme dans ľun ou ľautre groupe. A ľévaluation du dommage myocardique au moyen des courbes de la CK MB, on a trouvé des valeurs remarquablement basses et comparables chez les patients des deux groupes. Ainsi, on a trouvé une libération maximale de CK MB (CK MB MAX) de 8.1 ± 1 UI/1 chez les patients anesthésiés à ľenflurane et de 7.2 ± 1.32 UI/1 chez ceux ayant reçu de ľhalothane. Le calcul de la surface sous la courbe des CK MB a donné des valeurs de 144 ± 21.9 UI/1/h pour le groupe E et de 173 ± 32 UI/1/h pour le groupe H. Ľévaluation du dommage myocardique à partir de la CK MB accumulée (CK MB DS) s’est élevée à 10.5 ± 1.79 UI/1 chez les patients anesthésiés à ľenflurane et à 10.3 ± 2.26 UI/1 chez ceux ayant reçu de ľhalothane.
Il n’y a pas eu de libération de CK MB avant la CEC chez les patients de ľun et ľautre groupes.
On n’a pas trouvé de différences significatives dans les modifications hémodynamiques observées et dans les besoins en agents vaso-actifs avec ľun et ľautre des anesthésiques, bien qu’on ait observé une tendance à une plus grande utilisation de vasodilatateurs chez les patients anesthésiés à ľhalothane.
En conclusion, le taux de dommage myocardique observé après une anesthésie à ľhalothane ou à ľenflurane chez le coronarien est bas. La libération de CK MB est survenue après la CEC et reflète probablement une protection myocardique imparfaite. Nous n’avons pas étudié les malades présentant une mauvaise fonction ventriculaire; ľhalothane et ľenflurane doivent être utilisés judicieusement chez de tels patients.
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Reves, J.G., Samuelson, P.N., Lell, W.A. et al. Myocardial damage in coronary artery bypass surgical patients anaesthetized with two anaesthetic techniques: a random comparison of halothane and enflurane. Canad. Anaesth. Soc. J. 27, 238–247 (1980). https://doi.org/10.1007/BF03007434
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DOI: https://doi.org/10.1007/BF03007434