Transmural Redistribution of Myocardial Blood Flow during Isoflurane Anesthesia and Its Effects on Regional Myocardial Function in a Canine Model of Fixed Coronary Stenosis

Wilton, Niall; Knight, Paul R.; K, Ullrich; Martin, Bradley J.; Gallagher, Kim P.

doi:10.1097/00000542-199303000-00015

Cited by 13 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although control low-flow areas with absolute flow rates Ͻ0.4 mL ⅐ min Ϫ1 ⅐ g Ϫ1 do not show elevated adenosine concentrations, 5 local blood flows Ͻ0.6 mL ⅐ min Ϫ1 ⅐ g Ϫ1 during epicardial coronary artery constriction are associated with a reduction of myocardial contractile function 14 and a change of energy metabolism. 15,16 Thus, the question arises whether for a given global cardiac work, an absolute local flow threshold can be defined below which the myocardium must be considered underperfused.…”

mentioning

confidence: 96%

Coronary Reserve of High- and Low-Flow Regions in the Dog Heart Left Ventricle

1998

View full text Add to dashboard Cite

Background-Left ventricular myocardial blood flow is spatially heterogeneous. The hypothesis we tested was whether myocardial areas with a steady-state flow Ͻ0.5 times mean flow are underperfused and areas with flow Ͼ1.5 times mean flow are overperfused. Methods and Results-In anesthetized beagle dogs (nϭ10), the relationship between local blood flow versus S-adenosylhomocysteine (SAH) concentration, a measure of the free intracellular adenosine concentration, and lactate, a measure of the myocardial NADH/NAD ϩ ratio, were determined under control conditions and after coronary constriction. Control local myocardial blood flow was 0.99Ϯ0.46 mL ⅐ min Ϫ1 ⅐ g Ϫ1 , with a coefficient of variation of 0.36Ϯ0.12 (nϭ256 per heart; sample wet mass, 125Ϯ30 mg). Tissue concentrations of SAH (3.4Ϯ2.5 nmol/g) and lactate (1.88Ϯ0.80 mol/g) were not elevated in low-flow samples. However, after coronary artery constriction, poststenotic blood flow decreased from 1.00Ϯ0.27 to 0.49Ϯ0.22 mL ⅐ min Ϫ1 ⅐ g Ϫ1 (PϽ0.04), with significant correlation between local SAH and flow (rϭϪ0.59) and lactate and flow (rϭϪ0.50). Although nearly all samples from control high-flow regions showed increased SAH concentrations if relative flow after stenosis was Ͻ1.0, control low-flow samples frequently displayed low SAH concentrations. The percent reduction in flow determined the changes in the local SAH and lactate concentration, independent of the local control blood flow. Conclusions-When the coronary inflow is unrestricted, the oxygen supply to control low-flow regions meets metabolic demand. Flow to control high-flow regions reflects a higher local demand rather than overperfusion. Thus, blood flow heterogeneity most likely reflects differences in aerobic metabolism. (Circulation. 1998;98:262-270.)

show abstract

mentioning

confidence: 96%

Coronary Reserve of High- and Low-Flow Regions in the Dog Heart Left Ventricle

1998

View full text Add to dashboard Cite

show abstract

“…Generally, the cell signal transduction pathway is believed to be involved in pharmacologic pre conditioning that includes ‘RISK’‐kinase activation and inhibition of opening of the mitochondrial permeability transition pore 4,8 . In the current study, we hypothesized that LVH might lessen cardioprotective efficacy by reducing the beneficial coronary vasodilation response to sevoflurane administration that inhalation anaesthetics are generally known to confer 9 . The results of the present study indicate that although sevoflurane reduced infarct size to largely the same levels in LVH and in normal animals, the relative infarct size reduction was smaller in association with LVH (57% vs. 68%).…”

Section: Discussionmentioning

confidence: 93%

“…In LVH patients, a poorer outcome after ischaemia–reperfusion injury can be anticipated after cardiac surgery, because LVH is associated with abnormal myocardial microvascular morphology and function, and altered myocardial energetics 15–17 . In LVH, the microvascular response to vasodilator challenge is diminished both in vitro and in vivo , and is due to increased tissue pressure and thickening of capillary walls 7,9,15–19 …”

Section: Discussionmentioning

confidence: 99%

Hypertrophied hearts: what of sevoflurane cardioprotection?

Larsen¹,

Smerup

Hasenkam

et al. 2009

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…They also inhibit spontaneous ventilation and potentiate muscle relaxant's effects. Isoflurane induced coronary artery dilation may cause coronary steal phenomenon 47 . Rapid increase of desflurance may result in significant sympathetic stimulation.…”

Section: Inhalation Anestheticsmentioning

confidence: 99%

Conscious Sedation and Anesthesia in the Cardiac Electrophysiology Laboratory

Lin

Benditt

2012

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Adequate anesthesia is important for performing EP procedures such as catheter ablation and implantation of cardiac devices. A wide range of anesthesia options are available, and all can be safely administered in EP laboratory with proper monitoring, drug selection, airway management equipment, and trained personnel. In addition to knowing the patient's clinical status, a thorough understanding of the clinical pharmacology of each anesthetic agent is essential in order to select appropriate drug among a variety of available anesthetics, to monitor for adverse effects, and to ensure adequate sedation and anesthesia for a comfortable, safe, and successful procedure. After a general strategy of anesthesia is planned, an individual anesthetic agent or combination of agents can be selected based on their pharmacological properties while keeping in mind the desired sedation/anesthesia requirements. Since anesthetics are often used in combination, the synergistic interaction of several anesthetic agents (infiltrative, parenteral, and/or inhaled) needs to be considered. Further attention also needs to be paid to the interaction between anesthetics and other existing medications. Finally, all care providers should work collaboratively and communicate frequently to provide a safe and effective anesthesia.

show abstract

Transmural Redistribution of Myocardial Blood Flow during Isoflurane Anesthesia and Its Effects on Regional Myocardial Function in a Canine Model of Fixed Coronary Stenosis

Cited by 13 publications

References 0 publications

Coronary Reserve of High- and Low-Flow Regions in the Dog Heart Left Ventricle

Coronary Reserve of High- and Low-Flow Regions in the Dog Heart Left Ventricle

Hypertrophied hearts: what of sevoflurane cardioprotection?

Conscious Sedation and Anesthesia in the Cardiac Electrophysiology Laboratory

Contact Info

Product

Resources

About