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Anesth Analg 1988; 67:936-942
© 1988 International Anesthesia Research Society
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Global and Regional Myocardial Blood Flow and Metabolism during Equipotent Halothane and Isoflurane Anesthesia in Patients with Coronary Artery Disease

Hoshang J. Khambatta, MD, Hans Sonntag, MD, Reinhard Larsen, MD, Heidrun Stephan, MD, J. Gilbert Stone, MD, and Dietrich Kettler, MD

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, and University of Gottingen, Gottingen, Federal Republic of Germany.

Abstract

Global and regional myocardial blood flow and metabolism were examined in 20 patients with coronary artery disease before surgical stimulation. Half were anesthetized with halothane (0.8%) and half with isoflurane (1.2%). Coronary perfusion pressure decreased similarly in both groups. During halothane anesthesia coronary sinus blood flow, an index of global perfusion, decreased from an awake value of 129 ± 7 to 97 ± 7 ml/win (P < 0.05), and great cardiac rein blood flow, an index of regional perfusion, decreased from 60 ± 8 to 44 ± 5 ml/mm (P < 0.05). In contrast, during isoflurane anesthesia global coronary blood fine increased from 131 ± 13 to 153 ± 16 ml/min (P < 0.05), while regional blood flow decreased from 68 ± 7 to 56 ± 6 mVmin (P < 0.05). Thus, the ratio of great cardiac vein blood flow to coronary sinus blood flow was unchanged during halothane anesthesia but decreased significantly during isoflurane. Neither global nor regional coronary vascular resistance was altered by halothane, whereas isoflurane decreased global coronary vascular resistance without affecting regional coronary vascular resistance. All patients receiving halothane had net myocardial lactate extraction. In the isoflurane group, four patients showed global lactate production and three regional lactate production. All patients demonstrating lactate production also developed electrocardiographic evidence of myocardial ischemia, which was not present before induction. The authors conclude that halothane is a preferable anesthetic to isoflurane in patients with coronary artery disease because the latter has the propensity to induce maldistribution of the coronary circulation and myocardial ischemia.

Key Words: ANESTHETICS, VOLATILE—halothane, isoflurane. • HEART, MYOCARDIAL BLOOD FLOW, METABOLISM.




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[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1988 by the International Anesthesia Research Society.