Factors that determine the hemodynamic response to inhalation anesthetics.
The hemodynamic response to inhalation anesthesia is influenced by three factors: 1) the specific drug, 2) the dose, and 3) individual characteristics of the subject. To investigate the importance of these factors on the cardiovascular response, we administered five doses [0, 0.5, 1.0, 1.5, and 2.0 minimum alveolar concentration (MAC)] of enflurane, halothane, and isoflurane to each of six dogs. Twelve hemodynamic variables were measured. For all variables, a change in the dose of each drug produced a consistent effect in each dog. Increases in dose resulted in significant decreases in seven variables [left ventricular ejection fraction, cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular stroke work index (LVSWI), and heart rate (HR)] and a significant increase in one variable [central venous pressure (CVP)]. In contrast, the response of individual dogs to different drugs was not consistent. For seven variables [MAP, MPAP, LVSWI, CVP, pulmonary capillary wedge pressure (PCWP), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI)], a significant difference in the responses of a dog to two drugs was greater than zero, whereas a significant difference in the response of at least one other dog to the same two drugs was less than zero (discordant dog-drug interactions). Thus, in contrast to the consistency of the cardiovascular response to changes in dose, the hemodynamic response to different drugs was inconsistent among dogs. We also studied the effect of fluid challenge on hemodynamic response at 1.5 or 2.0 MAC of the three drugs given to each dog.(ABSTRACT TRUNCATED AT 250 WORDS)
Hoffman
W D
WD
Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland 20892.
Banks
S M
SM
Alling
D W
DW
Eichenholz
P W
PW
Eichacker
P Q
PQ
Parrillo
J E
JE
Natanson
C
C
D000280:Administration, Inhalation; D000777:Anesthetics / Q000008:administration & dosage / Q000494:pharmacology*; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004737:Enflurane / Q000008:administration & dosage / Q000494:pharmacology; D005740:Gases / Q000097:blood; D006221:Halothane / Q000008:administration & dosage / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D007530:Isoflurane / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D011652:Pulmonary Circulation / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects
D000777:Anesthetics; D005740:Gases; D004737:Enflurane; D007530:Isoflurane; D006221:Halothane