The Hemodynamic and Renal Effects of Sevoflurane and Isoflurane in Patients with Coronary Artery Disease and Chronic Hypertension

• Published in: Anesthesia and analgesia Vol. 82; no. 6; pp. 1159 - 1165
• Main Authors: Rooke, G. Alec, Ebert, Thomas, Muzi, Michael, Kharasch, Evan D.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-06-1996; Lippincott
• Subjects: Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Medical sciences; Neuropharmacology; Pharmacology. Drug treatments; Volatile compound; Human; Hypertension; Renal function; General anesthetic; Cardiovascular disease; General anesthesia; Fluorine Organic compounds; Hemodynamics; Coronary heart disease; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199606000-00010

In patients without significant cardiovascular disease, the hemodynamic effects of sevoflurane and isoflurane are similar; however, the hemodynamic effects of sevoflurane in patients with hypertension and ischemic heart disease are unknown.To examine the effects of sevoflurane in comparison to isoflurane in this highrisk population, 214 patients scheduled for elective surgery were enrolled if they had evidence of ischemic heart disease or multiple risk factors for ischemic heart disease. Patients were randomly assigned to receive sevoflurane (n = 106) or isoflurane (n = 108) for anesthetic maintenance in conjunction with fentanyl and nitrous oxide in oxygen. Deviations in arterial blood pressure or heart rate of more than 20% from preinduction values that persisted after adjustment of the volatile anesthetic concentration were treated with intravenous phenylephrine, ephedrine, nitroglycerin, atropine, or esmolol as needed. Creatinine, blood urea nitrogen (BUN), and urine protein were measured before surgery, immediately after surgery, and 24 and 48 h postoperatively. For analysis, patients were divided into those with and those without the diagnosis of chronic hypertension. Heart rate and arterial blood pressure responses to sevoflurane and isoflurane were not different for the patients with or without chronic hypertension. Neither anesthetic was associated with a more frequent treatment for hemodynamic deviation. After surgery, creatinine and BUN decreased in both the sevoflurane and isoflurane groups without significant differences between groups. The incidence of postoperative proteinuria was similar in the sevoflurane and isoflurane groups. We conclude that hemodynamic stability in patients with hypertension and ischemic heart disease is similar with sevoflurane and isoflurane. No differences in renal function were observed between the sevoflurane and isoflurane groups.(Anesth Analg 1996;82:1159-65)