Abstract
Purpose
In vitro, halogenated agents reduce the pulmonary vasoconstrictor response to alveolar hypoxia in isolated perfused lungs. However, studies in intact animals have been less convincing. The aim of the present study was to assess the effect of sub-MAC concentrations of desflurane on hypoxic pulmonary vasoconstriction (HPV) in anesthetized piglets using the pressure/cardiac output relationship (P/Q).
Methods
Eleven large white piglets were anesthetized and ventilated mechanically alternatively in hyperoxia (FiO2 = 0.4) and in hypoxia (FiO2 = 0.12). Multipoint plots of pulmonary arterial pressure (PAP), or differences between PAP and left atrial pressure (LAP) against Q were generated by gradual inflation of a balloon advanced into the inferior vena cava. P/Q relationships were established in hyperoxia and in hypoxia at baseline, and then with gradual concentrations of desflurane.
Results
In hypoxia, pressure gradients (RAP-LAP) increased significantly at every level of Q, demonstrating active pulmonary vasoconstriction. Desflurane did not affect these P/Q relationships either in hyperoxia, or in hypoxia, when compared with baseline.
Conclusion
Desflurane at a clinically relevant dose has no significant effect on HPV in anesthetized piglets.
Résumé
Objectif
La plupart des agents halogénés dont le desflurane inhibent la vasoconstriction pulmonaire hypoxique (VPH) sur le poumon isolé de mammifère. Le but de cette étude est d’évaluer les effets de cet halogéné sur la VPH du porc entier anesthésié, au moyen de la relation pression vasculaire trans-pulmonaire (PAP-POG)/débit cardiaque (Q).
Matériel et méthodes
Onze porcs (poids moyen 26 ± 4 kg) ont été inclus, après accord de la Commission d’éthique animale. Après prémédication, et anesthésié iv standardisées, ils ont été équipés d’une pression invasive artérielle fémorale, d’une sonde dans l’artère pulmonaire et d’une pression intra auriculaire G (POG) afin de déterminer les relations (PAP-POG)/débit Q. Le gradient PAP-POG) et le débit Q ont été mesurés durant le gonflement graduel d’un ballon intra-cave destiné à modifier le débit Q. Ces relations (PAP-POG)/Q ont été étudiées en hyperoxie (FiO2: 0,4) et en hypoxie (FiO2: 0,12), sans desflurane puis avec desflurane à des concentrations expirées de 2,5 et 5%. Pour chaque relation pression/débit, une équation de régression a été calculée. Une ANOVA pour mesures répétées et un test de Bonferroni ont été utilisés afin de déterminer l’effet du desflurane sur la relation (PAP-POG)/Q.
Résultats
En hypoxie, la pente des relations pression/débit a augmenté de façon significative, et ce pour chaque variation de Q mettant ainsi en évidence un phénomène de VPH active. Le desflurane n’a pas eu d’effet significatif sur les relations (PAP-POG)/Q en hyperoxie, ni en hypoxie.
Conclusion
Contrairement aux études in vitro, le desflurane n’inhibe pas, de façon significative la VPH du porc entier anesthésié.
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Kerbaul, F., Guidon, C., Stephanazzi, J. et al. Sub-MAC concentrations of desflurane do not inhibit hypoxic pulmonary vasoconstriction in anesthetized piglets. Can J Anesth 48, 760–767 (2001). https://doi.org/10.1007/BF03016691
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DOI: https://doi.org/10.1007/BF03016691