BACKGROUND:Airway irritation was hypothesized to trigger the transient cardiovascular stimulation associated with desflurane. The authors administered desflurane during cardiopulmonary bypass (CPB), thus avoiding airway contact, and compared the effects of rapid increases of desflurane to 1.5 MAC on systemic vascular resistance index (SVRI) and catecholamine response to those of 1.5 MAC sevoflurane.

METHODS:Forty-eight patients, undergoing elective coronary bypass surgery, were randomly allocated to receive either desflurane or sevoflurane during hypothermic (32-33 degrees C) nonpulsatile CPB at exhaust gas concentrations of 1.5 MAC for 15 min. SVRI was calculated at baseline, 1, 2, 3, 4, 5, 7, 9, 12, and 15 min after starting volatile anesthetics' delivery. Plasma catecholamine concentrations were determined in 12 desflurane-treated patients and 12 sevoflurane-treated patients at baseline, 5, and 15 min.

RESULTS:The time-course of deltaSVRI, (changes in SVRI from baseline), from baseline to 5 min was significantly different between desflurane- and sevoflurane-treated patients, whereas there was no difference from 7 to 15 min. In the desflurane group, SVRI from 1 to 7 min remained unchanged to baseline level, thereafter declining to significantly lower values at 9, 12, and 15 min compared with values from 0 to 5 min, whereas sevoflurane produced an immediate and significant reduction in SVRI. With desflurane, catecholamine concentrations remained unchanged to baseline level at 5 and 15 min; with sevoflurane, they decreased with time.

CONCLUSIONS:The authors' results indicate that desflurane is associated with a different hemodynamic and catecholamine response compared with sevoflurane when administered into the oxygenator's gas supply line during CPB.

译文

背景 : 假定气道刺激会触发与地氟醚相关的短暂心血管刺激。作者在体外循环 (CPB) 期间使用地氟醚,从而避免了气道接触,并比较地氟醚快速增加1.5 MAC对全身血管阻力指数 (SVRI) 和儿茶酚胺对1.5 MAC七氟醚反应的影响。
方法 : 48例接受择期冠状动脉搭桥手术的患者,在1.5 MAC的废气浓度下,在低温 (32-33 ℃) 非脉动CPB期间随机分配接受地氟醚或七氟醚15分钟。在开始挥发性麻醉剂递送后的基线,1、2、3、4、5、7、9、12和15分钟计算SVRI。在基线,5和15分钟确定了12例地氟醚治疗的患者和12例七氟醚治疗的患者的血浆儿茶酚胺浓度。
结果 : deltaSVRI的时间过程,(SVRI从基线变化),地氟醚和七氟醚治疗的患者从基线到5分钟有显着差异,而从7到15分钟没有差异。在地氟醚组中,从1到7分钟的SVRI与基线水平保持不变,此后在9、12和15分钟的值与0到5分钟的值相比下降至显着较低,而七氟醚在SVRI中立即显着降低。使用地氟醚时,儿茶酚胺的浓度在5和15分钟时保持与基线水平不变; 使用七氟醚时,它们会随时间降低。
结论 : 作者的结果表明,在CPB期间将地氟醚与七氟醚相比,与七氟醚相比,地氟醚与血液动力学和儿茶酚胺反应不同。

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