Effects of sevoflurane on cardiovascular dynamics, coronary circulation and myocardial metabolism in dogs
Tóm tắt
The effects of 2.5% and 5% of sevoflurane anesthesia on hemodynamics and myocardial metabolism were studied in pentobarbital-pancuronium anesthetized dogs. The interaction between nicardipine and 2.5% sevoflurane was also examined. Sevoflurane produced dose-dependent (P<0.05 toP<0.01) decreases in systolic arterial pressure (SAP), heart rate (HR), cardiac index (CI), left ventricular minute work index (LVMWI), maximum rate of rise of left ventricular pressure (LV dP/dt), the time constant of fall in isovolumic left ventricular pressure (T) and systemic vascular resistance (SVR), whereas stroke volume index (SVI) and left ventricular end-diastolic pressure (LVEDP) remained unchanged. Central venous pressure (CVP) was significantly (P<0.05) increased at 5%. Myocardial oxygen consumption
$$M\dot V_{O_2 } $$
, and myocardial lactate extraction ratio (ML ext) were decreased in a dose-dependent manner (P<0.05). Myocardial oxygen extraction ratio (MO
2 ext) was significantly (P<0.01) decreased at 5%. The ratio of the left ventricular minute work index to myocardial oxygen consumption
$$LVMWI/M\dot V_{O_2 } $$
, i.e., left ventricular efficiency was significantly decreased only at 5% (P<0.05). Coronary sinus blood flow (CSBF) was significantly (P<0.05) decreased only at 2.5% sevoflurane and coronary vascular resistance (CVR) was significantly (P<0.01) decreased only at 5% sevoflurane. The ratio of CSBF to CO (CSBF/CO) showed a tendency to increase as sevoflurane concentrations were increased. Nicardipine (0.01 mg·kg−1) administered intravenously under 2.5% sevoflurane caused significant (P<0.05 toP<0.01) decreases in SAP, HR, LV dP/dt, SVR, and CVR, and increases in CVP, SVI, CI, and CSBF (P<0.05 toP<0.01). CSBF/CO remained unchanged.
$$M\dot V_{O_2 } $$
, MO
2 ext, and ML ext were significantly (P<0.05 toP<0.01) decreased.
$$LVMWI/M\dot V_{O_2 } $$
showed a tendency to increase. It is concluded that sevoflurane causes a rapidly and easily controlled cardiovascular depression and may not have unfavorable effects on coronary circulation and myocardial metabolism. Nicardipine exerts a synergistic myocardial depressant effect on sevoflurane, in terms of both cardiovascular dynamics and myocardial metabolism.
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