[Can isoflurane be advised for controlled hypotension?].
Since 1983, many papers tell of the usefulness of isoflurane for induced hypotension. It can induce and maintain stable arterial hypotension during neurosurgery, or any other surgical procedure requiring induced hypotension. Its use has proved to be simple. Although other hypotensive techniques are possible, especially if only moderate hypotension is required, the mechanism of action of isoflurane is very appealing: it reduces arterial pressure by reducing the peripheral resistances, without reducing the output, unlike halothane or trinitrin. Moreover, as it is anaesthetic, it reduces the overall oxygen consumption, such that if there were a fall in output one could assume that it was related to the level of oxygen consumption. When there is no severe hypocapnia, isoflurane, quite unlike sodium nitroprusside, lowers cerebral oxygen consumption without affecting cerebral blood flow rate. It does however increase intracranial pressure, like all the other hypotensive agents used. It does not increase filling pressures and has no effect on blood gas movements, unlike sodium nitroprusside and trinitrin which increase filling pressures and the intrapulmonary shunt. It is not toxic either, unlike sodium nitroprusside. The expensiveness of the drug is balanced by its many advantages, all the more so as this cost can be reduced by using a filter-system for some cases (e.g. middle ear surgery), or by using some drug combinations which need yet to be defined. However, there exist some disadvantages which may, in fact, be due to experimental conditions: failure of induced hypotension, coronary ischaemia, doubtful cerebral protection in case of focal areas of ischemia, different degrees of organ vasodilation.(ABSTRACT TRUNCATED AT 250 WORDS)
Bernard
J M
JM
Département d'Anesthésie-Réanimation Chirurgicale, Hôtel-Dieu, Nantes.
Pinaud
M
M
D002560:Cerebrovascular Circulation / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D007427:Intracranial Pressure / Q000187:drug effects; D007530:Isoflurane / Q000494:pharmacology; D010100:Oxygen / Q000378:metabolism
D007530:Isoflurane; D010100:Oxygen
Peut-on conseiller l'isoflurane pour l'hypotension contrôlée?