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Canadian Journal of Anesthesia, Vol 31, 604-610, Copyright © 1984 by Canadian Anesthesiologists' Society

Myocardial Metabolism and Haemodynamic Responses with Enflurane Anaesthesia for Coronary Artery Surgery

EMERSON A. MOFFITT MD1, DAVID D. IMRIE MB1, JOHN E. SCOVIL MD1, JOHN J. GLENN MB1, CHARMAN L. COUSINS PHD1, CARLOS DELCAMPO MD1, JOHN A. SULLIVAN MD1, and C. EDWIN KINLEY MD1

1 Departments of Anaesthesia, Pathology and Surgery, Dalhousie University and the Maritime Heart Centre, Victoria General Hospital, Halifax, Nova Scotia

Address correspondence to: Dr. Emerson Moffitt, Sir Charles Tupper Medical Building, University Avenue, Halifax, Nova Scotia, Canada B3H 4H7.

Ten patients were studied before, during and after enflurane anaesthesia for coronary vein grafting. All had good ventricular function and nine were receiving effective beta blockade. Cardiac output and vascular pressures were measured, plus coronary sinus blood flow (CBF), myocardial oxygen consumption (MVO2) and lactate extraction (MLE). Enflurane induction (10 minutes, mean 1.72 per cent end tidal) reduced blood pressure (MAP), due to decreased cardiac index (CI), with no change in heart rate or systemic resistance. Intubation returned MAP and CI to control level but the heart rate increased. Subsequently, enflurane kept MAP, CI and stroke work below the awake level. CBF decreased on induction, rose again on intubation and remained normal before bypass. MVO2 fell on induction from an increase in CS oxygen content, which remained elevated. Normal MLE continued in every patient. There was no evidence of myocardial ischaemia in patients on beta blockade, when haemodynamics were maintained at or below those of the sedated, awake state.

Key Words: HEART: oxygen consumption • ANAESTHESIA: cardiovascular • ANAESTHETICS, VOLATILE: enflurane • SURGERY: cardiovascular






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Copyright © 1984 by the Canadian Anesthesiologists' Society.