The Risk of Myocardial Ischemia in Patients Receiving Desflurane versus Sufentanil Anesthesia for Coronary Artery Bypass Graft Surgery

Helman, James D.; Leung, Jacqueline M.; Bellows, Wayne H.; Pineda, Nonato; Roach, G.; Reeves, Jerry D.; Howse, J. D.; McEnany, M. Terry; Mangano, Dennis T.

doi:10.1097/00000542-199207000-00008

Cited by 112 publications

(28 citation statements)

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“…In many studies, sympathetic stimulation by volatile agents has been shown to be related to cardiac ischemia in patients of cardiovascular disease [4]. In our study, decreases in HR compared with that of the control group suggested that suppression of sympathetic activation by perioperative dexmedetomidine seems to specifically beneficial in patients with ischemic heart disease to prevent myocardial infarction [4,25]. The side effects of dexmedetomidine in high-risk patients or during surgery are severe hypotension and bradycardia requiring immediate treatments.…”

Section: Discussionsupporting

confidence: 52%

“…In addition, dexmedetomidine attenuates the hemodynamic and neuroendocrinal response of surgical trauma during heart surgery of high-risk adults and children as well [9,10,15,24]. In many studies, sympathetic stimulation by volatile agents has been shown to be related to cardiac ischemia in patients of cardiovascular disease [4]. In our study, decreases in HR compared with that of the control group suggested that suppression of sympathetic activation by perioperative dexmedetomidine seems to specifically beneficial in patients with ischemic heart disease to prevent myocardial infarction [4,25].…”

Section: Discussionmentioning

confidence: 99%

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Blunting effect of dexmedetomidine on transient cardiovascular changes induced by inhalation of desflurane: a randomized controlled trial

et al. 2018

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Blunting effect of dexmedetomidine on transient cardiovascular changes induced by inhalation of desflurane: a randomized controlled trial

et al. 2018

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“…Examples of this phenomenon exist for sufentanil, 52 midazolam, 3~ propofol, ~,s3 and perhaps desflulane. 54 Taken together, these studies support my bias that, provided the anaesthetist controls myocardial oxygen balance, understands the principles involved in anaesthetizing patients for CABG surgery, and intervenes early when adverse events occur, there is no ideal anaesthetic technique for CABG surgery. Certainly, the use of high doses of opioids as the primary anaesthetic technique could be usefully and safely abandoned to permit certain objectives, e.g., early tracheal extubation, alternative pain management techniques, to be studied in the postoperative period.…”

Section: Current Practicementioning

confidence: 70%

Anaesthesia for coronary artery surgery — a plea for a goal-directed approach

Hall

1993

Can J Anaesth

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“…1 Sympathetic stimulation leads to hypertension, tachycardia and, in select cases, myocardial ischemia. 5 Several of our previous studies have focused on determining methods to attenuate this potentially harmful response. For example, one study indicated that pretreatment with 2.5 µg·kg -1 fentanyl was insufficient, but pretreatment with 5.0 µg·kg -1 fentanyl was adequate to minimize the sympathetic activation and subsequent hemodynamic response to the administration of desflurane.…”

Section: Discussionmentioning

confidence: 99%

High concentrations of isoflurance do not block the sympathetic nervous system activation from desflurane

Ebert

Trotier

Arain

et al. 2001

Can J Anesth/J Can Anesth

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GENERAL ANESTHESIA 133 Purpose: The volatile anesthetic desflurane has been associated with neurocirculatory responses that have been relatively refractory to adjuvant treatment. We have employed desflurane to evaluate the integrity of the sympathetic nerve recording after establishment of the anesthetized state with another anesthetic agent. This retrospective evaluation of data from volunteers determined if higher concentrations of isoflurane that were sufficient to block the neurocirculatory response to laryngeal and tracheal stimulation would abolish the neurocirculatory response to desflurane. Methods: Data from eight, healthy, young volunteers met our criteria for inclusion. They had been anesthetized with propofol or thiopental and intubated after neuromuscular blockade. Each subject was monitored with radial artery blood pressure (BP), heart rate (HR)(ECG), and sympathetic microneurography. Isoflurane had been administered to achieve a steady state concentration of 1.5 MAC (minimum alveolar concentration) while oxygenation and carbon dioxide were monitored with pulse oximetry and infrared spectrometry, respectively. A deep level of anesthesia was confirmed when laryngoscopy and endotracheal tube movement failed to elicit a neurocirculatory response. A brief exposure to 11% desflurane in the inspired gas was then provided.Results: The responses to desflurane included significant increases in HR, range 32-84 b/min, and BP, range 15-72 mm Hg (P < 0.05). Sympathetic nerve activity increased substantially in the three volunteers with functional nerve recordings. Conclusion:In healthy volunteers receiving 1.5 MAC isoflurane, which was sufficient to block the neurocirculatory response to laryngoscopy and tracheal stimulation, there were striking increases in sympathetic outflow, HR and BP when 11% desflurane was substituted for isoflurane.Objectif : L'anesthésique volatil desflurane a été associé à des réponses neurocirculatoires relativement réfractaires à un traitement adjuvant. Nous avons utilisé le desflurane pour évaluer l'intégrité du nerf sympathique après l'installation de l'anesthésie avec un autre anesthésique. La présente évaluation rétrospective de participants volontaires a cherché à déterminer si une concentration élevée d'isoflurane, suffisante pour bloquer la réponse neurocirculatoire à la stimulation laryngée et trachéale, pouvait abolir la réponse neurocirculatoire au desflurane. Méthode : Huit jeunes volontaires en santé ont participé à l'étude. Ils ont été anesthésiés avec du propofol ou du thiopental et intubés après blocage neuromusculaire. Chaque patient a été surveillé par le monitorage de la tension de l'artère radiale (TA) et de la fréquence cardiaque (FC) (ECG) et par la microneurographie sympathique. L'isoflurane a été administré jusqu'à une concentration stationnaire de 1,5 CAM (concentration alvéolaire minimale) et l'oxygénation et le gaz carbonique ont été vérifiés par l'oxymétrie pulsée et la spectrométrie à infrarouge, respectivement. Un niveau profond d'anesthésie a été confirm...

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The Risk of Myocardial Ischemia in Patients Receiving Desflurane versus Sufentanil Anesthesia for Coronary Artery Bypass Graft Surgery

Cited by 112 publications

References 0 publications

Blunting effect of dexmedetomidine on transient cardiovascular changes induced by inhalation of desflurane: a randomized controlled trial

Blunting effect of dexmedetomidine on transient cardiovascular changes induced by inhalation of desflurane: a randomized controlled trial

Anaesthesia for coronary artery surgery — a plea for a goal-directed approach

High concentrations of isoflurance do not block the sympathetic nervous system activation from desflurane

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