Effects of rapid increases of desflurane and sevoflurane to concentrations of 1.5 MAC on systemic vascular resistance and catecholamine response during cardiopulmonary bypass.
BACKGROUND
Airway irritation was hypothesized to trigger the transient cardiovascular stimulation associated with desflurane. The authors administered desflurane during cardiopulmonary bypass (CPB), thus avoiding airway contact, and compared the effects of rapid increases of desflurane to 1.5 MAC on systemic vascular resistance index (SVRI) and catecholamine response to those of 1.5 MAC sevoflurane.


METHODS
Forty-eight patients, undergoing elective coronary bypass surgery, were randomly allocated to receive either desflurane or sevoflurane during hypothermic (32-33 degrees C) nonpulsatile CPB at exhaust gas concentrations of 1.5 MAC for 15 min. SVRI was calculated at baseline, 1, 2, 3, 4, 5, 7, 9, 12, and 15 min after starting volatile anesthetics' delivery. Plasma catecholamine concentrations were determined in 12 desflurane-treated patients and 12 sevoflurane-treated patients at baseline, 5, and 15 min.


RESULTS
The time-course of deltaSVRI, (changes in SVRI from baseline), from baseline to 5 min was significantly different between desflurane- and sevoflurane-treated patients, whereas there was no difference from 7 to 15 min. In the desflurane group, SVRI from 1 to 7 min remained unchanged to baseline level, thereafter declining to significantly lower values at 9, 12, and 15 min compared with values from 0 to 5 min, whereas sevoflurane produced an immediate and significant reduction in SVRI. With desflurane, catecholamine concentrations remained unchanged to baseline level at 5 and 15 min; with sevoflurane, they decreased with time.


CONCLUSIONS
The authors' results indicate that desflurane is associated with a different hemodynamic and catecholamine response compared with sevoflurane when administered into the oxygenator's gas supply line during CPB.
Rödig
G
G
University Hospital, Department of Anesthesia, University of Regensburg, Germany.
Keyl
C
C
Kaluza
M
M
Kees
F
F
Hobbhahn
J
J
D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D002395:Catecholamines / Q000097:blood*; D000077335:Desflurane; D004987:Ethers / Q000493:pharmacokinetics / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology; D008297:Male; D008738:Methyl Ethers; D011650:Pulmonary Alveoli / Q000378:metabolism*; D000077149:Sevoflurane; D014655:Vascular Resistance / Q000187:drug effects*
D018685:Anesthetics, Inhalation; D002395:Catecholamines; D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane