Isoflurane and Desflurane Impair Right Ventricular–Pulmonary Arterial Coupling in Dogs

Kerbaul, François; Rondelet, Benoît; Motte, Sophie; Fesler, Pierre; Hubloue, Ives; Ewalenko, Patricia; Naeije, Robert; Brimioulle, Serge

doi:10.1097/00000542-200412000-00016

Cited by 48 publications

(30 citation statements)

References 26 publications

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“…However, there were more severe patients undergoing RA, indicated by both haemodynamics and the fact that significantly more patients on specific PAH therapy received RA than GA. The use of GA may increase PVR through several mechanisms, including increased sympathetic stimulation during airway instrumentation on laryngoscopy [39], effects of volatile agents [40], high airway plateau pressure due to the effects of positive-pressure mechanical ventilation [12,13], hypoxia [15] and hypercapnia [16]. The present data suggested that more complications occurred in those with higher PET,CO 2 and peak airway pressure, although many confounding factors may affect these values.…”

Section: Discussionmentioning

confidence: 60%

“…The present data suggested that more complications occurred in those with higher PET,CO 2 and peak airway pressure, although many confounding factors may affect these values. Volatile anaesthetic agents may also adversely affect right ventricular preload and contractility [25], as well as afterload [40], although isoflurane has been used safely in human PAH [41]. Desflurane appears to exert worse pulmonary vascular effects than isoflurane, probably through sympathetic activation [42,43].…”

Section: Discussionmentioning

confidence: 99%

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Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

European Respiratory Journal

119

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The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described.The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics.A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n511, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n54), perioperative complication and death rates were higher (100 and 50%, respectively; p,0.005). Risk factors for complications were greater for emergency surgery (p,0.001), major surgery (p50.008) and a long operative time (193 versus 112 min; p50.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3-6 or 12 months of post-operative follow-up.Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

European Respiratory Journal

119

View full text Add to dashboard Cite

show abstract

“…The high mortality rate recorded in patients who underwent general anaesthesia might be explained by a downwards spiral of worsening right ventricular function. Indeed, general anaesthesia may increase PVR through several mechanisms including increased sympathetic stimulation during airway instrumentation and tracheal intubation [19], effects of volatile agents used for anaesthesia [20], high airway plateau pressure due to the effects of positive-pressure mechanical ventilation [21] and hypoxic pulmonary vasoconstriction caused by alveolar hypoxia [22].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in pulmonary arterial hypertension in the modern management era

et al. 2012

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Previous studies have reported mortality rates of up to 56% associated with pregnancy in pulmonary arterial hypertension (PAH) but the management of this disease has changed considerably in recent years.We compiled a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH.During a 3-yr period, the 13 participating centres reported 26 pregnancies. Three (12%) females died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were eight abortions; two spontaneous and six induced. 16 (62%) pregnancies were successful, i.e. the females delivered healthy babies without complications. These females had well controlled PAH (pulmonary vascular resistance (PVR) 500¡352 dyn?s?cm -5 ); eight of them were long-term responders to calcium channel blockers. In contrast, the females who died or required transplantation had poorly controlled PAH (PVR 1,667¡209 dyn?s?cm -5 ).Pregnancy remains associated with a substantial mortality rate in PAH. However, our results indicate that the outcome of pregnancy in PAH has improved, at least when PAH is well controlled, and particularly in long-term responders to calcium channel blockers. These data must be confirmed by larger series before the general recommendation to avoid pregnancy in all patients with PAH is reconsidered.

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“…Table 7 shows the effect of various anaesthetic agents on right ventricular contractility and afterload. Inhaled anaesthetics such as isoflurane and desflurane have a marked dose-dependent effect in reducing right ventricular contractility and some negative impact on right ventricular afterload; hence, they significantly impair right ventricle pulmonary artery coupling [46,47]. Sevoflurane causes significant depression of global right ventricular function associated with a qualitatively different effect on inflow and outflow tracts, without any modification of pulmonary vascular resistance [48].…”

Section: Principles Of Anaesthetic Managementmentioning

confidence: 99%

Pulmonary hypertension and its management in patients undergoing non‐cardiac surgery

2014

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SummaryPulmonary hypertension is a complex disorder of the pulmonary vasculature that leads to increased peri-operative morbidity and mortality. Non-cardiac surgery constitutes a significant risk in patients with pulmonary hypertension. The management of right ventricular failure is inherently challenging and fraught with life-threatening consequences. A thorough understanding of the pathophysiology, the severity of the disease and its treatment modalities is required to deliver optimal peri-operative care. This review provides an evidence-based overview of the definition, classification, pathophysiology, diagnosis and treatment of pulmonary hypertension and focuses on the peri-operative management and treatment of pulmonary hypertensive crises in a non-cardiac setting.

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Isoflurane and Desflurane Impair Right Ventricular–Pulmonary Arterial Coupling in Dogs

Abstract: Isoflurane and desflurane markedly impair RV-PA coupling efficiency in dogs, during hyperoxia and hypoxia, both by increasing RV afterload and by decreasing RV contractility.

Cited by 48 publications

References 26 publications

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Pregnancy outcomes in pulmonary arterial hypertension in the modern management era

Pulmonary hypertension and its management in patients undergoing non‐cardiac surgery

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