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

Abstract

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.

The effect of perioperative insulin treatment on cardiodepression in mild adiposity in mice

“…Some report decreased [ 8 , 13 , 17 , 18 ] others unchanged [ 19 ] or even improved [ 20 ] systolic function. Studies on cardiac function in obesity in the perioperative setting are rare, but have shown additional cardiodepressive effects of sevoflurane in diet-induced obese rats [ 8 ]. In our mild phenotype we found impaired fractional shortening but also load-independent end-systolic elastance, indicating that this is a true contractility effect.…”

“…(Contrast-enhanced) echocardiography was performed using a Siemens (ACUSON, Sequoia 512) device equipped with a 14 MHz linear array transducer as described previously [ 8 , 13 ]. Before infusion of contrast agent, contractile function was determined by visualizing the LV in short axis midpapillary view, and left ventricular end-systolic (ESD) and end-diastolic (EDD) diameters were determined in M-mode.…”

“…Contrast-echocardiography was performed as previously described [ 8 , 13 , 14 ]. Briefly, perfluorbutane filled microbubbles were continuously infused into the jugular vein and visualized in midpapillary short-axis views of the LV.…”

“…In obese, non-diabetic rats, adrenergic-mediated hemodynamic effects were distinctly affected by the volatile anesthetic isoflurane when compared to non-obese rats [ 7 ]. Moreover, diet-induced obesity in rats is associated with systolic dysfunction and myocardial perfusion disturbances when compared to lean animals, and sevoflurane anesthesia further aggravates this myocardial contractile response [ 8 ]. Since these animal studies suggest that even non-diabetic adiposity is associated with hemodynamic and cardiovascular disturbances in the perioperative period, more insight in the pathophysiology as well as possible treatment strategies are warranted.…”

Immunomodulatory effects of anesthetics in obese patients

“…This negative effect can be explained by reduced activation of the ROS-mediated AMPK signaling pathway[ 123 ]. In another study, van den Brom et al[ 124 ] showed that sevoflurane has a stronger depressant effect on myocardial function than other agents, thus possibly increasing cardiac vulnerability to limited oxygen supply and increasing risk of ischemia during surgery.…”