Comparison of the haemodynamic actions of desflurane/N2O and isoflurane/N2O anaesthesia in vascular surgical patients.
BACKGROUND
The purpose of this study was to compare heart rate and arterial blood pressure response to desflurane/N2O vs isoflurane/N2O anaesthesia in a randomized clinical trial performed in patients before vascular surgery.


METHODS
To evaluate associated changes in the autonomic nervous system with maintenance of anaesthesia, we used power spectral analysis (PSA) of heart rate and blood pressure and measured plasma catecholamine concentrations. Twenty-five patients whose trachea had been intubated after propofol induction were given either desflurane or isoflurane at 1 and 1.5 MAC in N2O (60%) in a random manner.


RESULTS
At an anaesthetic depth of up to 1.5 MAC, arterial blood pressure, indices of sympathetic activity derived from PSA, decreased with both anaesthetics, while heart rate and plasma catecholamine concentrations did not significantly change. Plasma renin activity significantly increased at 1.5 MAC anaesthesia in both groups.


CONCLUSIONS
We conclude that sympathetic hyperactivity previously reported during desflurane anaesthesia in healthy volunteers is not frequent in clinical practice in elderly vascular surgical patients under desflurane/N2O anaesthesia, since it occurs at an anaesthetic depth which cannot be reached in these patients because of the lowering arterial blood pressure effects of desflurane, which are similar to those of isoflurane.
Zubicki
A
A
Department of Anesthesiology and Intensive Care, Hôpital de la Pitié-Salpétrière, Paris, France.
Gostin
X
X
Miclea
D
D
Riou
B
B
Buy
E
E
Richer
C
C
Coriat
P
P
D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D002395:Catecholamines / Q000097:blood; D000077335:Desflurane; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000494:pharmacology*; D014656:Vascular Surgical Procedures
D018685:Anesthetics, Inhalation; D002395:Catecholamines; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide