Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, Part II: Effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia

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Hohner, P.Umeå universitet,Anestesiologi och intensivvård (author)

Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, Part II : Effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia

Article/chapterEnglish1994

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1994
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LIBRIS-ID:oai:DiVA.org:umu-142705
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-142705URI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Hohner, P Backman, C Diamond, G Friedman, A Haggmark, S Johansson, G Karp, K Reiz, S Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't Denmark Acta anaesthesiologica Scandinavica Acta Anaesthesiol Scand. 1994 Nov;38(8):793-804.
This study examines the effects of nitrous oxide on haemodynamics, anterior left ventricular (LV) function and incidence of myocardial ischaemia in abdominal vascular surgical patients with coronary artery disease. Forty-seven patients were randomly assigned to isoflurane-fentanyl anaesthesia with nitrous oxide-oxygen vs air-oxygen (control). Systemic and coronary haemodynamics, 12-lead ECG, LV anterior wall motion by cardiokymography (CKG) and myocardial lactate balance were recorded at four intervals: before and during anaesthesia and 10 and 30 minutes into surgery. Systemic haemodynamics were controlled by anaesthetic dose, and, when insufficient, by i.v. nitroglycerine (NG) in case of LV failure (PCWP > 18 mmHg) and by phenylephrine during hypotension. We found that nitrous oxide was associated with greater need for i.v. nitroglycerin (patients: P = 0.031, episodes P = 0.005) and more myocardial ischaemia (patients P = 0.012, episodes P = 0.001) despite systemic and coronary haemodynamics comparable to the control group. We conclude that nitrous oxide, known to have both sympathomimetic and cardiodepressive actions, produced cardiodepression in the face of sympathetic stimulation. Our study design did not allow to conclude if myocardial ischaemia was the consequence of increased wall stress or a reason for the observed LV dysfunction. The higher incidence of introperative myocardial ischaemia and need for NG did not cause increased cardiac morbidity.

Subject headings and genre

Abdomen/*surgery
*Anesthesia/adverse effects
Coronary Circulation/drug effects
Coronary Disease/metabolism/*physiopathology
Female
Fentanyl
Hemodynamics/*drug effects
Humans
Isoflurane
Male
Middle Aged
Myocardial Ischemia/*chemically induced
Myocardium/metabolism
Nitrogen
Nitrous Oxide/adverse effects/*pharmacology
Oxygen Consumption/drug effects
Postoperative Complications
*Vascular Surgical Procedures
Ventricular Function
Left/*drug effects

Added entries (persons, corporate bodies, meetings, titles ...)

Backman, C.Umeå universitet,Klinisk fysiologi (author)
Diamond, G. (author)
Friedman, A. (author)
Häggmark, S.Umeå universitet,Anestesiologi och intensivvård(Swepub:umu)kaso0008 (author)
Johansson, G.Umeå universitet,Anestesiologi och intensivvård(Swepub:umu)gojo0001 (author)
Karp, K.Umeå universitet,Klinisk fysiologi (author)
Reiz, S.Umeå universitet,Anestesiologi och intensivvård (author)
Umeå universitetAnestesiologi och intensivvård (creator_code:org_t)

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In:Acta Anaesthesiol Scand38:8, s. 793-804

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