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Canadian Journal of Anesthesia, Vol 30, 5-9, Copyright © 1983 by Canadian Anesthesiologists' Society

Nitrous Oxide added to Halothane Reduces Coronary Flow and Myocardial Oxygen Consumption in Patients with Coronary Disease

EMERSON A. MOFFITT MD1, DHUN H. SETHNA MD1, RICHARD J. GARY 1, MARJORIE J. RAYMOND RN1, JACK M. MATLOFF MD1, and JOHN A. BUSSELL MD1

1 Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia and the Departments of Anaesthesiology and Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, California

Address Correspondence to: E.A. Moffitt MD, Sir Charles Tupper Medical Building, University Avenue, Halifax, Nova Scotia B3H 4H7.

The haemodynamic and myocardial metabolic effects of adding 50 per cent nitrous oxide to 0.5 per cent halothane were studied in 13 patients, before the surgical incision for coronary artery vein grafts. Cardiac output and coronary sinus blood flow were determined by thermodilution, along with haemodynamic measurements. Measurements 15 minutes after addition of nitrous oxide revealed a significant decrease in heart rate, arterial pressure, cardiac index, coronary sinus blood flow and myocardial oxygen consumption. There was a significant increase in coronary sinus lactate content, and a significant decrease, from 27 to 11 per cent, in myocardial lactate extraction. We conclude that these circulatory changes were likely to be due to a depression of ventricular function by the nitrous oxide. The myocardia of these patients with severe coronary disease were becoming globally ischaemic while they were receiving 50 per cent oxygen, in the presence of hypotension. Nitrous oxide should be turned off when hypotension occurs in coronary patients.

Key Words: HEART: coronary disease, myocardial function, anaesthetics • ANAESTHETICS, GASES: nitrous oxide • BLOOD PRESSURE: drug effects






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Copyright © 1983 by the Canadian Anesthesiologists' Society.