Abstract
The actions of desflurane, isoflurane and halothane on regional tissue perfusion were studied using radioactive microspheres in dogs chronically instrumented for measurement of arterial and left ventricular pressure, global (left ventricular dP/dtmax) and regional (percent segment shortening) contractile function, and diastolic coronary blood flow velocity. Systemic and coronary haemodynamics and regional tissue perfusion were measured in the conscious state and during anaesthesia with equihypotensive concentrations of desflurane, isoflurane, and halothane. All three volatile anaesthetics (P < 0.05) increased heart rate and decreased mean arterial pressure, left ventricular systolic pressure, and left ventricular dP/dtmax Myocardial perfusion was unchanged in subendocardial, midmyocardial, andsubepicardial regions by the administration of either dose of desflurane. No redistribution of intramyocardial blood flow (endo/epi ratio) was observed during desflurane anaesthesia. Although regional myocardial perfusion was reduced (P < 0.05) in a doserelated fashion by halothane and by isoflurane at high concentrations, redistribution of intramyocardial blood flow was not observed during halothane or isoflurane anaesthesia. All three volatile anaesthetics reduced blood flow to the renal cortex, but only desflurane produced a decrease in renal cortical vascular resistance. Hepatic blood flow decreased in response to halothane but not desflurane or isoflurane. Concomitant decreases in hepatic resistance were observed during administration of desflurane and isoflurane. Doserelated decreases in intestinal and skeletal muscle blood flow were observed during halothane and isoflurane but not desflurane anaesthesia. The results suggest that desflurane maintains myocardial, hepatic, intestinal, and skeletal muscle blood flow while halothane and isoflurane decrease regional tissue perfusion in these vascular beds to varying degrees during systemic hypotension in the chronically instrumented dog.
Résumé
Ce travail étudie les effets du desflurane, de l’isoflurane et de l’halothane sur la perfusion régionale à l’aide de microsphères radioactives sur des chiens préparés à demeure pour mesures itératives de la tension artérielle et ventriculaire gauche, de la contractilité globale (dP/dtmax ventriculaire gauche) et régionale (index de raccourcissement segmentaire) ainsi que de la vélocité du débit coronarien diastolique. L’hémodynamique systémique et coronaire et la perfusion régionale ont été mesurées à l’état de conscience et pendant l’anesthésie avec des concentrations hypotensives équivalentes de desflurane, d’isoflurane et d’halothane. Les trois agents (P < 0,05) ont augmenté la fréquence cardiaque et diminué la tension artérielle moyenne et le dP/dtmax ventriculaire gauche. La perfusion myocardique est demeurée inchangée aux régions subendocardique, midendocardique et subépicardique pendant l’administration de desflurane. On n’observe pas de redistribution du débit intramyocardique (rapport endo./épi.) pendant l’anesthésie au desflurane. Bien que la perfusion régionale soit réduite (P < 0,05) de façon proportionnelle pour les concentrations élevées d’isoflurane et d’halothane, la redistribution de débit sanguin myocardique n’est pas observée pendant l’anesthésie avec ces agents. Alors que les trois agents volatils diminuent le débit sanguin au cortex rénal, seul le desflurane en diminue la résistance vasculaire. Le débit sanguin hépatique diminue sous halothane mais non sous isoflurane et desflurane. Une diminution simultanée des résistances hépatiques survient pendant l’administration de desflurane et d’isoflurane. Des baisses de débit sanguin à l’intestin et aux muscles squelettiques proportionnelles à la concentration sont observées pendant l’anesthésie à l’halothane et l’isoflurane mais ne surviennent pas sous desflurane. Ces résultats suggèrent le maintien par le desflurane des débits sanguins myocardique, hépatique, intestinal et musculaire alors que l’halothane et l’isoflurane diminuent la perfusion tissulaire régionale de ces lits vasculaires à différents degrés pendant l’hypotension systémique chez le chien.
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Supported in part by USPHS grant HL 36144, VA Medical Research Funds, and Anesthesiology Research Training Grant GM 08377.
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Hartman, J.C., Pagel, P.S., Proctor, L.T. et al. Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs. Can J Anaesth 39, 877–887 (1992). https://doi.org/10.1007/BF03008300
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DOI: https://doi.org/10.1007/BF03008300