The echocardiographic assessment of left ventricular performance during sevoflurane and halothane anesthesia

The cardiovascular effects of sevoflurane were studied and compared with those of halothane in 30 healthy patients. The patients were assigned to receive 1MAC sevoflurane (n = 10), 2MAC sevoflurane (n = 10) or 1MAC halothane (n = 10) in N₂O 2l·min^–1 and O₂ 4l·min^–1. The changes in left ventricular diastolic and systolic dimension (Dd and Ds), fractional shortening (FS), mean velocity of circumferential fiber shortening (mVcf), left ventricular diastolic and systolic volume (Vd and Vs), stroke volume (SV), ejection fraction (EF) and cardiac index (CI) were evaluated by echocardiography. Sevoflurane produced significant dose-dependent decreases in FS, mVcf, EF and SV, but no significant changes in Dd and Vd. Therefore, the decrease in SV was due mainly to the increase in left ventricular residual volume (Vs). One MAC halothane produced a more significant decrease in FS, mVcf, EF and SV, when compared to values obtained at 1MAC sevoflourane (P 0.01). CI was more significantly decreased with 1MAC halothane than with 1MAC and 2MAC sevoflurane (P 0.01). This was brought about by a slight decrease in HR with halothane and a slight increase in HR with sevoflurane, in addition to a smaller decrease in SV with sevoflurane than with halothane. This study suggests that sevoflurane may better preserve cardiac function as a pump in healthy patients, when compared to halothane.(Kasuda H, Akazawa S, Shimizu R.: The echocardiographic assessment of left ventricular performance during sevoflurane and halothane anesthesia. J Anesth 4: 295–302, 1990)     

氟烷和七氟醚对兔肝细胞DNA及RNA的影响

实验选用健康家兔４２只，随机分为三组：对照组、氟烷组及七氟醚组。两实验组在应用氟烷和七氟醚后取其肝组织用流式细胞仪测定肝细胞ＤＮＡ、ＲＮＡ含量及细胞周期的变化情况。结果氟烷组用药后肝细胞ＤＮＡ含量与对照组相比无统计学差异，而该组的肝细胞增殖周期及ＲＮＡ含量均发生明显变化。七氟醚组此三项指标均未出现有统计学意义的变化。由此说明氟烷和七氟醚不会影响肝细胞ＤＮＡ的合成。氟烷组的变化主要反映肝细胞损伤后修复的过程。     

Effects of sevoflurane and halothane anesthesia on liver circulation and oxygen metabolism in the dog during hepatolobectomy

Purpose Effects of sevoflurane and halothane anesthesia on liver circulation and oxygen metabolism during hepatolobectomy were investigated in the dog, with the aim of choosing a better anesthetic for hepatic resection. Methods Sixteen mongrel dogs were randomly divided into two groups with eight in each. Electromagnetic flowmeters were used to measure hepatic arterial and portal venous blood flows (1) before the inhalation of each anesthetic (base line); (2) 1 h after the start of inhalation of 1.5 minimum alveolar concentration (MAC) anesthetic; (3) 1 h after hepatolobectomy with the same MAC of anesthesia; and (4) 2 h after the discontinuation of anesthesia. Measurements of systemic hemodynamics, blood gas tensions, plasma enzyme leaks and arterial ketone body ratio were made at the same time. Results Sevoflurane maintained hepatic arterial blood flow better than halothane anesthesia, both before and after hepatolobectomy. Hepatic arterial vascular resistance increased in the halothane group but did not change in the sevoflurane group after hepatolobectomy. No significant difference was found in oxygen metabolism and arterial ketone body ratio between two groups. Serum enzyme leakage was less in the sevoflurane group. Conclusion Sevoflurane has less adverse effects on liver circulation, especially hepatic arterial blood flow, and hepatic function than halothane in the case of hepatolobectomy.     

Comparison of the epinephrine-induced arrhythmogenic effect of sevoflurane with isoflurane and halothane

The effect of sevoflurane on cardiac arrhythmias induced by the infusion of epinephrine into dogs was compared with those of isoflurane and halothane. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine and the corresponding plasma levels obtained by a series of three-minute epinephrine infusions during sevolurane, isoflurane, and halothane anesthesia at 1.25 MAC. The mean values of the arrythmogenic infusion rates of epinephrine and the corresponding plasma levels were 17.3µg/kg/min and 275.7ng/ml for sevoflurane, 6.7µg/kg/min and 149.2ng/ml for isoflurane and 1.9µg/kg/min and 39.1ng/ml for halothane, respectively. These results indicate that the arrythmogenic doses of epinephrine during sevoflurane and isoflurane anesthesia were significantly higher than those during halothane anesthesia.(Imamura S et al.: Comparison of the epinephrine-induced arrhythmogenic effect of sevoflurane with isoflurane and halothane. J Anesth 1: 62–68, 1987)     

The comparative cardiovascular effects of sevoflurane with halothane and isoflurane

Using closed chest dogs, the cardiovascular effects of sevoflurane were compared with those of halothane and isoflurane in equipotent doses of 1.0, 1.5, 2.0, 2.5 and 3.0 MAC. They were evaluated by the changes of arterial blood pressure, central venous pressure, pulmonary artery pressure, maximum rate of left ventricular pressure rise (LV dp/dt), cardiac output and coronary sinus blood flow. The suppression of left cardiac function by sevoflurane was less than that of halothane, but was greater than that of isoflurane. Heart rate, systemic vascular resistance with sevoflurane were slightly lower than that of isoflurance. The coronary sinus blood flows with sevoflurane and isoflurane were significantly (P < 0.05 at 1.0 MAC, P < 0.005 at 2.0 MAC) higher than halothane. There was no significant difference on coronary sinus flow between sevoflurane and isoflurane. The depth of anesthesia could be quickly changed by adjustment of inspired sevoflurane concentration in comparison with the other two anesthetics.(Kazama T, Ikeda K: The comparative cardiovascular effects of sevoflurane with halothane and isoflurane. J Anesth 2: 63–68, 1988)     

七氟醚和异氟醚对肝硬化患者肝切除术后肝功能的影响

目的 比较七氟醚和异氟醚对肝硬化患者行肝切除术后肝功能变化的影响.方法 将40名年龄为40～70岁的肝硬化(Child-Pugh A级),择期行肝癌肝叶切除术的患者随机分为七氟醚组和异氟醚组.两组患者均以咪唑安定0.1mg/kg体重、舒芬太尼0.4μg/kg体重、哌库溴铵1mg/kg体重诱导,分别予七氟醚或异氟醚辅以舒芬太尼维持麻醉.分别于术前、术后1、3、7d抽取非输液侧上肢静脉血测谷草转氨酶、谷丙转氨酶、总胆红素、碱性磷酸酶、胆碱酯酶、白蛋白、凝血酶原时间和血小板计数.结果 两组患者血清谷草转氨酶、谷丙转氨酶和碱性磷酸酶较术前明显升高,术后3d达峰,且其增高值在异氟醚组明显高于七氟醚组;术后无患者出现肝衰竭或肝损伤的临床表现.结论 在肝硬化患者的麻醉中,异氟醚对肝功能的影响可能强于七氟醚.     

Circulatory and catecholamine responses to tracheal intubation and skin incision during sevoflurane, isoflurane, or halothane anesthesia

The anesthetic suppression of responses to noxious stimuli might reflect a summation of the suppression of the basal functions and the response capability. We investigated the basal suppression and response capability in hemodynamics and plasma catecholamine levels with different anesthetics at the same minimum alveolar concentration (MAC) level. Fifty-four patients were allocated to one of 6 groups to receive sevoflurane, isoflurane, or halothane at 1.25 or 2.0 MAC. Anesthesia was induced with the test agent in oxygen and the end-tidal concentration of the agent was maintained for at least 15 min at 1.25 or 2.0 MAC. The trachea was intubated under muscle relaxation with 0.1 mg·kg⁻¹ vecuronium. Skin incisions were made after maintaining the end-tidal concentration of the agent for at least 15 min after tracheal intubation. The mean arterial pressure, heart rate, rate-pressure product, and plasma levels of noradrenaline and adrenaline at the prestimuli period showed no difference between agents at each MAC. The rises in these variables by tracheal intubation and skin incision were greatest in the sevoflurane group, least in the halothane group, and intermediate in the isoflurane group. Although basal hemodynamic suppression is similar at the same MAC, the suppressive action of sevoflurane on the circulatory response capability to noxious stimuli is weaker than that of isoflurane and halothane. This study was presented in part at the 42nd annual congress of the Japan Society of Anesthesiology, April 20, 1995     

Postanesthetic respiratory depression in humans: A comparison of sevoflurane,isoflurane and halothane

The postanesthetic respiratory depression with sevoflurane, isoflurane and halothane was studied in twenty-one patients. They were divided into three groups of seven patients each. One group underwent sevoflurane anesthesia, another group isoflurane and the third group halothane. Following extubation, the decrease in blood concentration of the anesthetic agent was most rapid with sevoflurane and slowest with halothane. Twenty minutes following extubation, resting ventilation and ventilatory response to carbon dioxide returned to the preanesthetic state with sevoflurane and isoflurane anesthesia. With halothane anesthesia, however, the depressive respiratory effects of halothane remained; depressed ventilatory response to carbon dioxide, decreased tidal volume and increased respiratory frequency. Although halothane has been reported to have the least depressive respiratory effect of the three, its elimination was slowest. Thus the respiratory effects of halothane persisted up to and past the twenty minute mark, far longer than with sevoflurane or isoflurane.(Doi M, Ideda K: Postanesthetic respiratory depression in humans: A comparison of sevoflurane, isoflurane and halothane. J Anesth 1: 137–142, 1987)     

Hypoxic ventilatory response in cats lightly anesthetized with ketamine: effects of halothane and sevoflurane in low concentrations

The effect of low concentration sevoflurane and halothane on the ventilatory response to isocapnic hypoxia was studied in sixteen cats. The cats were divided into two groups, sevoflurane group and halothane group, of eight subjects each. As parameters of the hypoxic ventilatory response, A value [the slope of the hyperbolic curve, _E = ₀ + A/(Pa_{O 2}-32)] and ratio of ₅₀ (the minute volume obtained from the hyperbolic equation when Pa_{O 2} = 50mmHg) to ₀ were studied. These two parameters were examined at three states, sedative state with ketamine as the control, ketamine plus 0.1MAC inhalation anesthetic, and ketamine plus 0.5MAC inhalation anesthetic.In the sevoflurane group, the A values were 4789 ± 1518, 2187 ± 1214, 1730 ± 880 (mean ± SE. ml·min^–1·mmHg) at the control state, 0.1MAC and 0.5MAC, respectively. In the halothane group, the A values were 6411 ± 2368, 2529 ± 842 and 2372 ± 545, respectively. The ratios of ₅₀ to ₀ were 1.32 ± 0.09, 1.22 ± 0.09, 1.25 ± 0.08 in the sevoflurane group, 1.47 ± 0.18, 1.32 ± 0.11, 1.54 ± 0.18 in the halothane group, respectively. The A value at 0.1MAC of the halothane group was less than the control value significantly. This proved that even low concentration halothane depressed the hypoxic ventilatory responses. The depression of hypoxic ventilatory response could cause postanesthetic hypoventilation. On the other hand, we could not find significant depression on the hypoxic ventilatory response in the sevoflurane group, but we should notice that variances of the hypoxic ventilatory response were large.(Tamura C, Doi M, Ikeda K: Hypoxic ventilatory response in cats lightly anesthetized with ketamine: Effects of halothane and sevoflurane in low concentrations. J Anesth 5: 233–238, 1991)     

Comparison of the placental transfer of halothane,enflurane, sevoflurane,and isoflurane during cesarean section

The concentrations of placental transfer of halothane (H), enflurane (E), sevoflurane (S), and isoflurane (I) were measured in 46 patients during cesarean section. The mean inhalation times of H (0.5%), E (1%), S (0.8%), and I (0.6%) were 13 min 27 s, 13 min 49s, 13 min 20s, and 8 min 8s, respectively. The mean concentrations in the maternal artery (MA) were 5.2mg·dl⁻¹ in H, 12.3 mg·dl⁻¹ in E, 5.2mg·dl⁻¹ in S, and 2.4mg·dl⁻¹ in I. The concentration ratio between the MA and the fetal umbilical vein (UV) was 0.44 for H, 0.49 for E, and 0.38 for S, and these ratios were not significantly different for these anesthetics. Although the concentration ratio for I (0.27) was significantly lower than those of the other three anesthetics, the UV:MA ratio was calculated to be 0.4 for an inhalation time 13 min. Our result, therefore, suggests that if the inhalation times were equal, the ratios of placental transfer would not differ among these four inhalational anesthetics. The Apgar scores in these four groups were not different from that in the group given only 66% nitrous oxide in oxygen as anesthetic (N₂O group). The cardiovascular changes induced by skin incision were bigger in the N₂O group than in the other groups. The use of a low concentration of H, E, S, or I is, therefore, suggested to be a useful and acceptable anesthetic method for cesarean section.     

七氟醚与异氟醚吸入麻醉对肾移植患者术后早期肾功能的影响比较

目的 比较七氟醚与异氟醚吸入麻醉对肾移植患者术后早期肾功能影响的差异,为吸入麻醉药的选择提供借鉴.方法 对106例全身麻醉下行同种异体肾移植的终末期肾病患者的临床资料进行分析,按照吸入麻醉药物的不同,将患者分成七氟醚组(74例)和异氟醚组(32例),比较分析术后早期肾功能变化特点.结果 与术前相比,两组患者术后第1日、...     

Anticonvulsant effects of sevoflurane on amygdaloid kindling and bicuculline-induced seizures in cats: comparison with isoflurane and halothane

Purpose. We compared the anticonvulsant effects of sevoflurane with those of isoflurane and halothane in amygdaloid kindling and bicuculline-induced seizures in cats. Methods. In a crossover design, the effects of 70% nitrous oxide, and 0.3, 0.6, and 1.5 minimum alveolar concentration (MAC) of volatile anesthetics were studied in five cats in which the amygdala was electrically stimulated at the current used for establishing the kindled state. The effects of 0.6 and 1.5 MAC of volatile anesthetics were studied in another five cats, in which 0.2 mg·kg⁻¹ of bicuculline was administered IV. Results. In the amygdaloid kindling model, all four anesthetics decreased the duration of after-discharge (AD), the rise of multiunit activity in midbrain reticular formation (R-MUA), and the behavior scores compared with findings without anesthetics. Halothane, at 1.5 MAC, significantly decreased the number of cats showing AD (P < 0.05). In the bicuculline-induced seizure model, all five cats showed repetitive spikes during 1.5 MAC of sevoflurane, whereas only two and three cats, respectively, showed the repetitive spikes during 1.5 MAC of isoflurane and halothane. All three volatile anesthetics decreased the rise of R-MUA, the duration of the repetitive spikes, and the behavior scores. The suppression of the rise in R-MUA and the behavior scores with 1.5 MAC of sevoflurane was significantly less than that with 1.5 MAC of isoflurane. Conclusion. The anticonvulsant effects of sevoflurane were less potent than those of halothane in the amygdaloid kindling model and less potent than those of isoflurane in the bicuculline-induced seizure model. Received: January 11, 2001 / Accepted: May 9, 2001     

Effects of four volatile anesthesics on postanesthetic ventilation: a comparison of halothane,enflurane, isoflurane,and sevoflurane

To investigate the effects of four volatile anesthetics (halothane, enflurane, isoflurane, and sevoflurane) on postanesthetic ventilation and levels of consciousness, we enrolled 24 patients undergoing tympanoplasty in this study. Anesthesia was maintained with 67% nitrous oxide and one of four volatile anesthetics. We measured end-tidal carbon dioxide concentration (C_ETco₂), minute volume ( ) and respiratory rate (RR), and determined the volatile anesthetic concentration in whole arterial blood (C_BAnesth) and arterial carbon dioxide tension (Paco₂) at 20 min and 2h after tracheal extubation. We also observed the level of consciousness (awake, drowsy, and asleep) before the measurement. Ventilatory variables were similar among the four groups at 20 min, although the ratio of volatile anesthetic concentration in the alveoli to the minimum alveolar concentration (MAC) (C_AAnesth/MAC ratio) calculated from C_BAnesth in the halothane group was twice those in the other groups. In the halothane group, Paco₂ was significantly higher, and and RR were significantly lower compared with the isoflurane and sevoflurane groups at 2h. Halothane tended to prolong the recovery of levels of consciousness. We conclude that isoflurane and sevoflurane provide clinical advantages over halothane on postanesthetic ventilation and recovery of levels of consciousness.     

Electrophysiologic effects of volatile anesthetics,sevoflurane and halothane,in a canine myocardial infarction model

The effects of sevoflurane and halothane on the effective refractory period (ERP) and ventricular activation were examined in a canine myocardial infarction model. Sevoflurane (1 MAC) reduced the heart rate and prolonged ERP in both normal and infarcted zones. A prolongation of ERP with sevoflurane was observed also during atrial pacing at a fixed rate, but the effect was less than during sinus rhythm. Sevoflurane either further delayed or blocked the delayed activation entirely in the infarcted zones with only slight effects on the activation of the normal zones. Halothane (1 MAC) prolonged ERP during sinus rhythm and atrial pacing, but to a lesser extent during the latter. Halothane also depressed ventricular activation in the infarcted zone during atrial pacing. In conclusion, sevoflurane as well as halothane selectively depresed the delayed activation and the prolongation of ERP in myocardial infarction, which may inhibit ventricular arrhythmias in myocardial infarction.     

七氟醚对肢体缺血再灌注大鼠肝损伤的影响

目的探讨七氟醚对肢体缺血再灌注大鼠肝损伤的影响。方法健康SD大鼠24只,体重200～250g,随机分为3组,各8只:假手术组(Sham组),只进行手术操作不做其他处理;肢体缺血再灌注组(IR组),双后肢缺血4h、再灌注6h;七氟醚组(S组)于再灌注前吸入2.5%七氟醚6h。IR、Sham组只吸入氧气。实验结束断头处死大鼠,于下腔静脉取血测定血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)的含量。摘取肝脏测定肝组织匀浆超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的含量,光学显微镜下观察组织病理学结果。结果与Sham组比较,IR组和S组ALT、AST、MDA、TNF-α和IL-6含量升高,SOD含量降低(P<0.01),肝组织损伤明显;与IR组比较,S组ALT、AST、MDA、TNF-α和IL-6含量降低,SOD含量升高(P<0.05),肝组织损伤减轻。结论七氟醚对肢体缺血再灌注大鼠肝损伤具有一定程度的保护作用,其机制可能与其减少氧自由基的释放和抑制炎症反应有关。     

择期手术病人七氟醚全麻诱导的效果

目的 比较七氟醚和异丙酚全麻诱导的效果。方法 择期手术病人60例,ASAⅠ级或Ⅱ级,年龄18～64岁,行全身麻醉。随机分为2组（n=30）：七氟醚组（S组）,吸入1MAC七氟醚麻醉诱导;异丙酚组（P组）,靶控输注血浆靶浓度3 mg/L异丙酚麻醉诱导,2组均靶控输注血浆靶浓度4μg/L瑞芬太尼。病人入室静卧5min后记录血压（BP）、心率（HR）作为基础值。记录插管前即刻、插管后1、2、3min的BP和HR以及病人意识消失的时间。结果 与基础值比较,插管前即刻2组BP下降,S组HR减慢（P＜0．01）;插管后1min P组BP下降（P＜0．01）;插管后3min S组BP下降（P＜0．05）。插管后3 min,P组HR较S组快（P＜0．05）。S组意识消失时间短于P组（P＜0．01）。结论 七氟醚用于全麻诱导,是一种安全有效、方便快捷的技术。     

吸入七氟醚与丙泊酚复合雷米芬太尼麻醉在全胃切除手术中的比较

目的 比较七氟醚吸入与丙泊酚复合雷米芬太尼麻醉在全胃切除手术中的应用效果.方法 40例ASA Ⅰ或Ⅱ级择期全胃切除术患者随机均分为七氟醚组(S组)和丙泊酚复合雷米芬太尼组(P组).记录围麻醉期各时点的血流动力学、脑电双频指数(BIS)、麻醉药浓度及用量、麻醉恢复期时间和苏醒期不良反应.结果 麻醉期两组DBP、MAP、HR均较麻醉前显著下降(P<0.05).两组患者术中均能维持足够的麻醉深度(BIS 45～60),术中血流动力学平稳.麻醉恢复期P组躁动、呛咳发生率明显低于S组(P<0.05).结论 七氟醚吸入麻醉或丙泊酚复合雷米芬太尼静脉麻醉均可安全应用于全胃切除手术.     

七氟醚对肝脏的影响

肝脏是重要的代谢器官,在手术中有许多因素影响肝脏的功能,麻醉药物就是其中一个重要的因素.七氟醚是一种广泛应用于国内外的吸入麻醉药.既往有诸多的研究发现七氟醚对肝功能和肝血流均有影响,但其机制目前还不完全清楚.现对既往七氟醚对肝脏的影响的研究进行综述.     

七氟醚吸入麻醉在老年患者经直肠前列腺穿刺活检术中的应用

目的探讨七氟醚吸入麻醉应用于老年患者经直肠前列腺穿刺活检术的安全性及对术后短期认知功能的影响。方法选择经直肠前列腺行穿刺活检术患者100例,年龄65~80岁,ASAⅠ或Ⅱ级。随机分为七氟醚组(S组)和丙泊酚组(P组),每组50例,分别采用七氟醚吸入麻醉和丙泊酚静脉麻醉,均行12针穿刺。记录麻醉前(T0)、麻醉后即刻(T1)、术中(T2)、术毕即刻(T3)的MAP、HR,记录患者入睡时间、唤醒时间;于麻醉前和术后30min采用简易智能精神状态检查量表(MMSE)行认知功能检查;记录术中低血压、心动过缓、呼吸抑制和体动的发生情况。结果与T0时比较,T1时两组患者MAP明显降低,P组HR明显减慢(P0.05);与T1时比较,T2、T3时两组患者MAP明显升高,P组HR明显增快(P0.05);T1时P组HR明显慢于S组(P0.05)。两组患者入睡时间、唤醒时间差异无统计学意义。与麻醉前比较,术后30min P组MMSE评分明显降低且明显低于S组(P0.05)。S组术中心动过缓及体动发生率明显低于P组(P0.05),呼吸抑制发生率低于P组。结论与丙泊酚静脉麻醉比较,七氟醚吸入麻醉用于经直肠前列腺穿刺活检术,对呼吸循环及术后短期认知功能影响小。