20 de agosto de 2013

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

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

Anesth Analg 2013;116:767–74

Background: Preservation of myocardial perfusion during general anesthesia is likely important in patients at risk for perioperative cardiac complications. Data related to the influence of general anesthesia on the normal myocardial circulation are limited. In this study, we investigated myocardial microcirculatory responses to pharmacological vasodilation and sympathetic stimulation during general anesthesia with sevoflurane in healthy humans immediately before surgical stimulation.

Methods: Six female and 7 male subjects (mean age 43 years, range 28–61) were studied at baseline while awake and during the administration of 1 minimum alveolar concentration sevoflurane. Using myocardial contrast echocardiography, myocardial blood flow (MBF) and microcirculatory  variables were assessed at rest, during adenosine-induced hyperemia, and after cold pressor test–induced sympathetic stimulation. MBF was calculated from the relative myocardial blood volume multiplied by its exchange frequency (ß) divided by myocardial tissue density (ρT), which was set at 1.05 g·mL-1.

Results: During sevoflurane anesthesia, MBF at rest was similar to baseline values (1.05 ± 0.28 vs 1.05 ± 0.32 mL·min-1·g-1; P = 0.98; 95% confidence interval [CI], -0.18 to 0.18). Myocardial blood volume decreased (P = 0.0044; 95% CI, 0.01–0.04) while its exchange frequency (ß) increased under sevoflurane anesthesia when compared with baseline. In contrast, hyperemic MBF was reduced during anesthesia compared with baseline (2.25 ± 0.5 vs 3.53 ± 0.7 mL·min-1·g-1; P = 0.0003; 95% CI, 0.72–1.84). Sympathetic stimulation during sevoflurane anesthesia resulted in a similar MBF compared to baseline (1.53 ± 0.53 and 1.55 ± 0.49 mL·min-1·g-1; P = 0.74; 95% CI, -0.47 to 0.35).

Conclusion: In otherwise healthy subjects who are not subjected to surgical stimulation, MBF at rest and after sympathetic stimulation is preserved during sevoflurane anesthesia despite a decrease in myocardial blood volume. However, sevoflurane anesthesia reduces hyperemic MBF, and thus MBF reserve, in these subjects.

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