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Isoflurane and coronary heart disease
N M Agnew1, S H Pennefather, G N Russell
1Department of Anaesthesia, The Cardiothoracic Centre Liverpool NHS Trust, Thomas Drive, Liverpool L14 3PE, UK.
Anaesthesia
|April 10, 2002
Summary
Isoflurane, once thought to cause coronary steal, is now recognized for its myocardial protective effects. Maintained coronary perfusion pressure prevents issues, making isoflurane a preferred anesthetic for heart disease patients.
Area of Science:
- Anesthesiology
- Cardiology
- Pharmacology
Background:
- Early research suggested isoflurane posed risks for coronary heart disease patients due to potential coronary steal.
- Subsequent studies have challenged these findings, indicating safety when coronary perfusion pressure is maintained.
Purpose of the Study:
- To evaluate the myocardial effects of isoflurane in patients with coronary heart disease.
- To assess the potential myocardial protective properties of isoflurane.
Main Methods:
- Review of early studies and subsequent clinical trials on isoflurane's effects on myocardial ischemia.
- Analysis of animal and human studies investigating isoflurane's mechanism of myocardial protection.
Main Results:
- Isoflurane does not induce coronary steal or myocardial ischemia if coronary perfusion pressure is maintained.
- Evidence suggests isoflurane offers myocardial protection, limiting infarct size and improving recovery.
- The protective mechanism involves adenosine triphosphate-dependent potassium channels, mimicking ischemic preconditioning.
Conclusions:
- Isoflurane is a safe and potentially beneficial anesthetic for patients with coronary heart disease.
- Its myocardial protective properties make it the anesthetic agent of choice in this patient population.