Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation

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Hohner, PerUmeå universitet,Anestesiologi och intensivvård (författare)

Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I : Isoflurane produces dose-dependent coronary vasodilation

Artikel/kapitelEngelska1994

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1994
printrdacarrier

Nummerbeteckningar

LIBRIS-ID:oai:DiVA.org:umu-66531
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-66531URI

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Språk:engelska
Sammanfattning på:engelska

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Ämneskategori:art swepub-publicationtype

Anmärkningar

Hohner, P Nancarrow, C Backman, C Haggmark, S Johansson, G Friden, H Diamond, G Friedman, A 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):780-92.
The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, i.v. phenylephrine and nitroglycerine were administered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (P < 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Anestesi och intensivvård hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Anesthesiology and Intensive Care hsv//eng
Abdomen/*surgery
Aged
Aged
80 and over
*Anesthesia/adverse effects
Coronary Circulation/*drug effects
Coronary Disease/*physiopathology
Dose-Response Relationship
Drug
Double-Blind Method
Female
Fentanyl/adverse effects/pharmacology
Halothane/adverse effects/pharmacology
Humans
Isoflurane/adverse effects/*pharmacology
Male
Middle Aged
Myocardial Ischemia/chemically induced/diagnosis/physiopathology
Myocardium/metabolism
Oxygen Consumption/drug effects
Vascular Resistance/drug effects
*Vascular Surgical Procedures
Vasodilation/*drug effects

Biuppslag (personer, institutioner, konferenser, titlar ...)

Nancarrow, CraigUmeå universitet,Anestesiologi och intensivvård (författare)
Backman, Clas (författare)
Häggmark, SörenUmeå universitet,Anestesiologi och intensivvård(Swepub:umu)kaso0008 (författare)
Johansson, GöranUmeå universitet,Anestesiologi och intensivvård(Swepub:umu)gojo0001 (författare)
Fridén, Håkan (författare)
Diamond, George (författare)
Friedman, Arnold (författare)
Reiz, SebastianUmeå universitet,Anestesiologi och intensivvård (författare)
Umeå universitetAnestesiologi och intensivvård (creator_code:org_t)

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Ingår i:Acta Anaesthesiol Scand38:8, s. 780-92

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Av författaren/redakt...: Hohner, Per; Nancarrow, Craig; Backman, Clas; Häggmark, Sören; Johansson, Göran; Fridén, Håkan; visa fler...; Diamond, George; Friedman, Arnold; Reiz, Sebastian; visa färre...

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