A Comparison of Desflurane and Isoflurane in Patients Undergoing Coronary Artery Surgery

Thomson, Ian R.; Bowering, John; Hudson, Robert J.; Frais, Michael A.; Rosenbloom, Morley

doi:10.1097/00000542-199111000-00008

Cited by 37 publications

(13 citation statements)

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“…HR remained unchanged until just before CPB when it increased slightly to reach a mean of 67 beat min" 1 . The depression of MAP and stability of HR are consistent with previous reports in which end-tidal desflurane concentrations of 2.6% [6] to 6% [1] were administered, but contrast with the tachycardia noted following inspired concentrations of 10.9% [7] and end-tidal concentrations of 9-12% [1].…”

Section: Discussionsupporting

confidence: 90%

“…This increase in arterial Pco 2 may also have contributed to the higher MPAP after fentanyl anaesthesia compared with desflurane at the end of induction. MPAP did not increase after desflurane anaesthesia at any time, confirming previous results [6]. At laryngoscopy there was no change in MAP or HR from induction values, indicating adequate obtunding of responses, as noted also with desflurane.…”

Section: Discussionsupporting

confidence: 89%

“…The early changes in cardiac performance with desfiurane were similar to previous reports using 2.5% [6] or 6% [1] end-tidal desfiurane with an initial decrease in CI (ns), associated with no change in PCWP or CVP but LVSWI was reduced. This suggests a reduction in ventricular work which is not caused by increased afterload as both MAP and SVRI are lower than awake values.…”

Section: Discussionsupporting

confidence: 86%

“…technique, desflurane reduced the need for intervention with vasodilator drugs at times of surgical stress and did not increase the requirement for either vasopressor or inotropic agents. Desflurane anaesthesia produced a decrease in systemic arterial pressures, as described previously for desflurane [1,6] and for halothane, enflurane and isoflurane [5]. This lasted until the start of surgery when MAP returned to awake values for the duration of incision and sternotomy.…”

Section: Discussionmentioning

confidence: 86%

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Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

Parsons¹,

Jones²,

Wrigley³

et al. 1994

British Journal of Anaesthesia

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We have compared, in 51 ASA II and III patients undergoing coronary artery bypass surgery, an inhaled anaesthetic technique based on desflurane, supplemented with low-dose (10 micrograms kg-1) fentanyl, with an i.v. technique using high-dose (50 micrograms kg-1) fentanyl with midazolam for induction. Satisfactory records were available for analysis in 50 patients. There were no differences between groups in operating time, cardiopulmonary bypass time, aortic cross-clamp time or duration of stay in the intensive care unit after surgery. Desflurane maintained mean systemic arterial pressure at the awake level during incision and sternotomy (end-tidal concentrations 3.7% and 4.6%, respectively) but decreased it significantly at all other times. With fentanyl, mean systemic arterial pressure was unchanged from awake values during induction and laryngoscopy but increased significantly at incision and sternotomy by 8% and 12.8%, respectively, to exceed the desflurane group at sternotomy by 20 mm Hg (P < 0.001). With desflurane, heart rate remained at 60-67 beat min-1 at all times before cardiopulmonary bypass. This was always lower than the fentanyl group by 5-15 beat min-1 and the difference was significant at induction, during skin preparation and before aortic cannulation. In comparison with the desflurane group, cardiac index was significantly greater in the fentanyl group at induction, laryngoscopy and during skin preparation, but was significantly less before aortic cannulation. The need for vasodilator intervention was significantly more common in the fentanyl group before, during and after cardiopulmonary bypass and for beta adrenoceptor block before cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 86%

See 2 more Smart Citations

Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

Parsons¹,

Jones²,

Wrigley³

et al. 1994

British Journal of Anaesthesia

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show abstract

“…Three groups of investigators have studied the effect of desflurane in patients undergoing coronary artery bypass graft surgery. Thomson et al [27] compared desflurane with isoflurane in groups of 21 and 20 patients. Both groups were given fentanyl 10 pg.kg-l, and during induction of anaesthesia the maximum end-tidal anaesthetic concentrations were 6% desflurane or 1.2% isoflurane.…”

Section: Humansmentioning

confidence: 99%

Cardiovascular effects of desflurane in experimental animals and volunteers

Weiskopf

1995

Anaesthesia

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Summary Desflurane (dijluoromethyl-l Key wordsDesjurane; cardiovascular effects. Desflurane(difluoromethyl-l-fluoro-2,2,2-trifluoroethyl ether [I-6531) was introduced into clinical practice in the autumn of 1992. The cardiovascular actions of this anaesthetic, which is chemically similar to isoflurane (the sole difference is that the chlorine atom in isoflurane is replaced by a fluorine atom in desflurane), were well-summarised at that time by Warltier and Pagel [I]. More recently, Eger [2] reviewed the pharmacology of the new inhaled anaesthetics. The present review summarises the current state of knowledge of the cardiovascular effects of desflurane, with emphasis on investigations published in the past 2 years, and compares the effects of desflurane with those of isoflurane and, where possible, sevoflurane. Experimental animalsThe initial investigations with desflurane in animals suggested that cardiovascular effects were similar to those of isoflurane [3-51. In chronically instrumented swine both anaesthetics produced a dose-related decrease in systemic vascular resistance and mean arterial blood pressure, an increased heart rate and maintained cardiac output at I minimum alveolar concentration (MAC), but produced dose-related decreases in cardiac output at higher concentrations. Pagel et al. [6] investigated the systemic and coronary haemodynamic actions of desflurane in chronically instrumented dogs, with intact or pharmacologically blocked autonomic nervous systems, and compared the effects with those produced by isoflurane, halothane and enflurane. With an intact autonomic system, desflurane appeared to maintain myocardial contractility (as assessed by peak left ventricular dP/dt and dP/dtso) better than did the other inhaled anaesthetics. When the autonomic system was blocked pharmacologically, this difference disappeared, suggesting that desflurane produced a lesser decrease of sympathetic tone than the other halogenated, inhaled anaesthetics. The same laboratory recently reported that sevoflurane is closer in this regard to isoflurane, enflurane and halothane than to desflurane [7]. Pagel et al. [6] also reported that both isoflurane and desflurane increased diastolic coronary blood flow velocity, suggesting that both anaesthetics may dilate the coronary arterial circulation. When heart rate was prevented from increasing during autonomic nervous system blockade, however, in contrast to isoflurane, desflurane

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Herzchirurgie

Schmid¹,

Gattiker²

1995

Anästhesiologie

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A Comparison of Desflurane and Isoflurane in Patients Undergoing Coronary Artery Surgery

Cited by 37 publications

References 0 publications

Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

Cardiovascular effects of desflurane in experimental animals and volunteers

Herzchirurgie

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