General Anesthesia with Sevoflurane Decreases Myocardial Blood Volume and Hyperemic Blood Flow in Healthy Humans

Bulte, Carolien S. E.; Slikkerveer, Jeroen; Kamp, Otto; Heymans, Martijn W.; Loer, Stephan A.; Marchi, Stefano F. de; Vogel, Rolf; Boer, Christa; Bouwman, R. Arthur

doi:10.1213/ane.0b013e31827e4e41

Cited by 10 publications

(10 citation statements)

References 43 publications

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“…This was in accordance with our previous study in healthy volunteers [17]. Also, diabetics tended to have a larger decrease in MBF than healthy controls.…”

Section: Discussionsupporting

confidence: 93%

“…We prospectively studied 6 patients with type 2 (non-insulin dependent) diabetes mellitus and 8 healthy control subjects, all scheduled for non-cardiac surgery under general anaesthesia. Six out of 8 healthy volunteers were selected based on sex from a previously published study by Bulte et al [17]. The diabetic subjects had haemoglobin A1c levels of 6.8 ± 0.8% (range 5.5 – 7.6%) and fasting glucose levels of 8.5 ± 1.5 mmol/l (range 6.7 – 10.9 mmol/l).…”

Section: Methodsmentioning

confidence: 99%

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Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot study

Bulte

Brom

Loer

et al. 2014

Cardiovasc Diabetol

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BackgroundIn type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction. The influence of sevoflurane anaesthesia on myocardial endothelial dysfunction in type 2 diabetic mellitus is investigated in this pilot study.MethodsSix males with type 2 diabetes mellitus and eight healthy controls were included. Using myocardial contrast echocardiography, myocardial blood flow (MBF) was measured at rest, during adenosine-induced hyperaemia (endothelium-independent vasodilation) and after sympathetic stimulation by the cold pressor test (endothelium-dependent vasodilation). Measurements were performed before and after induction of sevoflurane anaesthesia.ResultsSevoflurane anaesthesia decreased resting MBF in diabetics but not in controls (P = 0.03), while baseline MBF did not differ between diabetics and controls. Without anaesthesia, adenosine-induced hyperaemia increased MBF in both groups compared to resting values. Adenosine combined with sevoflurane resulted in a lower hyperaemic MBF in both groups compared to no anaesthesia. Differences in MBF in response to adenosine before and after sevoflurane administration were larger in diabetic patients, however not statistically significant in this pilot group (P = 0.08). Myocardial blood flow parameters after the cold pressor test were not different between groups.ConclusionThese pilot data in type 2 diabetic patients show that sevoflurane anaesthesia decreases resting myocardial blood flow compared to healthy controls. Further, we observed a trend towards a lower endothelium-independent vasodilation capacity in diabetic patients under sevoflurane anaesthesia. Endothelium-dependent vasodilation was not affected by sevoflurane in diabetic patients. These data provide preliminary insight into myocardial responses in type 2 diabetic patients under general anaesthesia.Trial registrationhttp://www.clinicialtrials.gov, NCT00866801

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“…This was in accordance with our previous study in healthy volunteers [17]. Also, diabetics tended to have a larger decrease in MBF than healthy controls.…”

Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot study

Bulte

Brom

Loer

et al. 2014

Cardiovasc Diabetol

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“…2 Additionally, sevoflurane provides smooth volatile induction due to its lack of airway irritation, and it is often used as an induction agent. [3][4][5] Desflurane has the lowest solubility of currently available volatile anesthetics, 6 which may allow for more rapid emergence and recovery than sevoflurane. 7 Additionally, the use of desflurane is associated with more predictable emergence and recovery than sevoflurane.…”

Section: Résumémentioning

confidence: 99%

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Mikuni

Harada

Yakushiji

et al. 2015

Can J Anesth/J Can Anesth

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“…Custom-designed software was used for analysis of the estimate of perfusion (Matlab, 7.10, R2010A, MathWorks Inc. Massachusetts, USA) [ 6 , 14 ]. For each cardiac cycle, regions of interest were drawn in the end-systolic frame in the posterior wall in the long-axis view of the left ventricle.…”

Section: Methodsmentioning

confidence: 99%

“…Sevoflurane has vasodilating properties and is known to reduce coronary vascular resistance [ 3 ] and perfusion pressure [ 4 , 5 ]. We showed that sevoflurane did not affect myocardial blood flow in cardiovascular healthy patients, while myocardial flow reserve was decreased [ 6 ]. Animal studies however showed that sevoflurane, when perfusion pressure remained constant, increased coronary blood flow in dogs [ 7 ] and decreased coronary flow reserve in isolated rat hearts [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats

Brom

Boly

Bulte

et al. 2016

Journal of Diabetes Research

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Preservation of myocardial perfusion during surgery is particularly important in patients with increased risk for perioperative complications, such as diabetes. Volatile anesthetics, like sevoflurane, have cardiodepressive effects and may aggravate cardiovascular complications. We investigated the effect of sevoflurane on myocardial perfusion and function in prediabetic rats. Rats were fed a western diet (WD; n = 18) or control diet (CD; n = 18) for 8 weeks and underwent (contrast) echocardiography to determine perfusion and function during baseline and sevoflurane exposure. Myocardial perfusion was estimated based on the product of microvascular filling velocity and blood volume. WD-feeding resulted in a prediabetic phenotype characterized by obesity, hyperinsulinemia, hyperlipidemia, glucose intolerance, and hyperglycemia. At baseline, WD-feeding impaired myocardial perfusion and systolic function compared to CD-feeding. Exposure of healthy rats to sevoflurane increased the microvascular filling velocity without altering myocardial perfusion but impaired systolic function. In prediabetic rats, sevoflurane did also not affect myocardial perfusion; however, it further impaired systolic function. Diet-induced prediabetes is associated with impaired myocardial perfusion and function in rats. While sevoflurane further impaired systolic function, it did not affect myocardial perfusion in prediabetic rats. Our findings suggest that sevoflurane anesthesia leads to uncoupling of myocardial perfusion and function, irrespective of the metabolic state.

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General Anesthesia with Sevoflurane Decreases Myocardial Blood Volume and Hyperemic Blood Flow in Healthy Humans

Cited by 10 publications

References 43 publications

Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot study

Myocardial blood flow under general anaesthesia with sevoflurane in type 2 diabetic patients: a pilot study

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats

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