Isoflurane and coronary heart disease.
Early studies indicated that isoflurane caused coronary steal and should therefore be avoided in patients with coronary heart disease. Subsequently, more detailed trials have disputed this and have shown that as long as coronary perfusion pressure is maintained, isoflurane does not cause coronary steal or myocardial ischaemia. There is now growing evidence, initially in animal work but more recently in human studies, that isoflurane has myocardial protective properties, limiting infarct size and improving functional recovery from myocardial ischaemia. The mechanism for this protection mimics ischaemic preconditioning and involves the opening of adenosine triphosphate-dependent potassium channels. The few studies comparing the myocardial protection offered by individual anaesthetic agents indicate that isoflurane represents the anaesthetic agent of choice for patients with coronary heart disease.
Agnew
N M
NM
Department of Anaesthesia, The Cardiothoracic Centre Liverpool NHS Trust, Thomas Drive, Liverpool L14 3PE, UK.
Pennefather
S H
SH
Russell
G N
GN
D000255:Adenosine Triphosphate / Q000378:metabolism; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology*; D003327:Coronary Disease / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D007530:Isoflurane / Q000494:pharmacology*; D017202:Myocardial Ischemia / Q000139:chemically induced; D009206:Myocardium / Q000378:metabolism
D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D000255:Adenosine Triphosphate; D007530:Isoflurane