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Heart rate limitation and cardiac unloading in sevoflurane post‐conditioning
Author(s) -
LARSEN J. R.,
SIVESGAARD K.,
CHRISTENSEN S. D.,
HØNGE J. L.,
HASENKAM J. M.
Publication year - 2012
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02580.x
Subject(s) - medicine , cardiology , myocardial infarction , heart rate , cardiac output , anesthesia , cardioprotection , rate pressure product , sevoflurane , ischemia , blood pressure , hemodynamics
Background Sevoflurane post‐conditioning ( SePost ) has been found to alleviate ischemic myocardial reperfusion injury through the activation of prosurvival kinases. Lowered myocardial oxygen demand from reduced cardiac work may also contribute to cardioprotection, and is much less well‐studied. Our aim was to examine the simultaneous effects of SePost on cardiac work (here, rate–pressure product, RPP ) and myocardial infarct size in a porcine model. Methods Anesthetized 25 kg pigs were randomly allocated to two groups and underwent 45 min regional coronary artery balloon occlusion and subsequent 2 h reperfusion. SePost ( n = 10) was given as sevoflurane 1.5–3% end‐tidal concentration during reperfusion while controls ( n = 12) were untreated. Aortic blood pressure was measured directly, while mixed‐venous oxygen saturation and cardiac output were measured in the pulmonary artery. Cardiac work was determined as RPP. Post‐mortem, histologic myocardial infarct size ( IS ), and area at risk were determined in transverse heart slices after tetrazolium stain. Results Myocardial infarct size was reduced from (control) 55.0 (mean) ± 13.6% (standard deviation) to 32.5 ± 13.4% in group SePost ( P = 0.0009). During reperfusion, SePost resulted in lower heart rate ( P = 0.0003), cardiac output ( P = 0.0123), mixed‐venous oxygen saturation ( P = 0.0103), blood pressure, and RPP ( P < 0.0001). RPP was highly correlated to IS ( P = 0.0055). Conclusion SePost (1.5–3%) reduced infarct size after regional myocardial ischemia in vivo and reduced cardiac work was significantly correlated to myocardial salvage.