Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial
The effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surge...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
PeerJ Inc.
2016-01-01
|
| Series: | PeerJ |
| Subjects: | |
| Online Access: | https://peerj.com/articles/1619.pdf |
| _version_ | 1797420284698951680 |
|---|---|
| author | José Hinz Ashham Mansur Gerd G. Hanekop Andreas Weyland Aron F. Popov Jan D. Schmitto Frank F. G. Grüne Martin Bauer Stephan Kazmaier |
| author_facet | José Hinz Ashham Mansur Gerd G. Hanekop Andreas Weyland Aron F. Popov Jan D. Schmitto Frank F. G. Grüne Martin Bauer Stephan Kazmaier |
| author_sort | José Hinz |
| collection | DOAJ |
| description | The effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surgery. Twenty patients undergoing CABG surgery were studied. Patients were assigned to an isoflurane or control group. Hemodynamic and flow measurements during CABG surgery were performed twice (15 minutes after the discontinuation of extracorporeal circulation (T15) and again 15 minutes later (T30)). The zero flow pressure intercept (a measure of COP) was extrapolated from a linear regression analysis of the instantaneous diastolic P-F relationship. In the isoflurane group, the application of isoflurane significantly increased the slope of the diastolic P-F relationship by 215% indicating a mean reduction of Coronary Vascular Resistance (CVR) by 46%. Simultaneously, the Mean Diastolic Aortic Pressure (MDAP) decreased by 19% mainly due to a decrease in the systemic vascular resistance index by 21%. The COP, cardiac index, heart rate, Left Ventricular End-Diastolic Pressure (LVEDP) and Coronary Sinus Pressure (CSP) did not change significantly. In the control group, the parameters remained unchanged. In both groups, COP significantly exceeded the CSP and LVEDP at both time points. We conclude that short-term application of isoflurane at a sedative concentration markedly increases the slope of the instantaneous diastolic P-F relationship during CABG surgery implying a distinct decrease with CVR in patients undergoing CABG surgery. |
| first_indexed | 2024-03-09T06:59:23Z |
| format | Article |
| id | doaj.art-ad2f9b735c184956bda05377f780f2d1 |
| institution | Directory Open Access Journal |
| issn | 2167-8359 |
| language | English |
| last_indexed | 2024-03-09T06:59:23Z |
| publishDate | 2016-01-01 |
| publisher | PeerJ Inc. |
| record_format | Article |
| series | PeerJ |
| spelling | doaj.art-ad2f9b735c184956bda05377f780f2d12023-12-03T09:56:30ZengPeerJ Inc.PeerJ2167-83592016-01-014e161910.7717/peerj.1619Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trialJosé Hinz0Ashham Mansur1Gerd G. Hanekop2Andreas Weyland3Aron F. Popov4Jan D. Schmitto5Frank F. G. Grüne6Martin Bauer7Stephan Kazmaier8Department of Anesthesiology, University Medical Center Goettingen, GermanyDepartment of Anesthesiology, University Medical Center Goettingen, GermanyDepartment of Anesthesiology, University Medical Center Goettingen, Goettingen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University of Oldenburg, Oldenburg, GermanyDepartment of Cardiothoracic Surgery, Transplantation & Mechanical Support, Royal Brompton & Harefield Hospital, London, United KingdomDepartment of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, GermanyDepartment of Anesthesiology, Erasmus University/Rotterdam, Rotterdam, NetherlandsDepartment of Anesthesiology, University Medical Center Goettingen, Göttingen, GermanyDepartment of Anesthesiology, University Medical Center Goettingen, Goettingen, GermanyThe effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surgery. Twenty patients undergoing CABG surgery were studied. Patients were assigned to an isoflurane or control group. Hemodynamic and flow measurements during CABG surgery were performed twice (15 minutes after the discontinuation of extracorporeal circulation (T15) and again 15 minutes later (T30)). The zero flow pressure intercept (a measure of COP) was extrapolated from a linear regression analysis of the instantaneous diastolic P-F relationship. In the isoflurane group, the application of isoflurane significantly increased the slope of the diastolic P-F relationship by 215% indicating a mean reduction of Coronary Vascular Resistance (CVR) by 46%. Simultaneously, the Mean Diastolic Aortic Pressure (MDAP) decreased by 19% mainly due to a decrease in the systemic vascular resistance index by 21%. The COP, cardiac index, heart rate, Left Ventricular End-Diastolic Pressure (LVEDP) and Coronary Sinus Pressure (CSP) did not change significantly. In the control group, the parameters remained unchanged. In both groups, COP significantly exceeded the CSP and LVEDP at both time points. We conclude that short-term application of isoflurane at a sedative concentration markedly increases the slope of the instantaneous diastolic P-F relationship during CABG surgery implying a distinct decrease with CVR in patients undergoing CABG surgery.https://peerj.com/articles/1619.pdfCoronary blood flowCardiac surgeryCardiac anesthesiaCritical care medicineHemodynamic monitoringCardio |
| spellingShingle | José Hinz Ashham Mansur Gerd G. Hanekop Andreas Weyland Aron F. Popov Jan D. Schmitto Frank F. G. Grüne Martin Bauer Stephan Kazmaier Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial PeerJ Coronary blood flow Cardiac surgery Cardiac anesthesia Critical care medicine Hemodynamic monitoring Cardio |
| title | Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial |
| title_full | Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial |
| title_fullStr | Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial |
| title_full_unstemmed | Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial |
| title_short | Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial |
| title_sort | influence of isoflurane on the diastolic pressure flow relationship and critical occlusion pressure during arterial cabg surgery a randomized controlled trial |
| topic | Coronary blood flow Cardiac surgery Cardiac anesthesia Critical care medicine Hemodynamic monitoring Cardio |
| url | https://peerj.com/articles/1619.pdf |
| work_keys_str_mv | AT josehinz influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT ashhammansur influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT gerdghanekop influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT andreasweyland influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT aronfpopov influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT jandschmitto influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT frankfggrune influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT martinbauer influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial AT stephankazmaier influenceofisofluraneonthediastolicpressureflowrelationshipandcriticalocclusionpressureduringarterialcabgsurgeryarandomizedcontrolledtrial |