Canadian Journal of Anaesthesia

, Volume 35, Supplement 1, pp S9–S13 | Cite as

Anaesthesia for the patient with cardiac disease

  • John H. Tinker

Summary and conclusions

I have tried to summarize experimental work in human and animal models. This work is complex and difficult to interpret. Clinicians should not take isolated experimental studies and jump to conclusions about clinical use of anaesthetics. Experimenters should not arrive at sweeping conclusions based on a particular experimental study performed under some or other carefully or not so carefully controlled conditions. Editorialists, such as Becker12 in a recent issue of Anesthesiology, should not conclude that an anaesthetic is “dangerous,” based on these kinds of studies. It is especially invalid to use the term “dangerous” unless the author is willing to present us with a viable, experimentally proven, safer alternative. To tell us that isoflurane is “dangerous” implies that we should switch to some unspecified other agent.

What conclusions can be arrived at based on these studies? (1) It is possible to produce coronary steal, in dogs, at constant coronary flow, with isoflurane at 41 mmHg perfusion pressure. The comparison between halothane and isoflurane is suspect because is was performed at two markedly different coronary perfusion pressures. (2) Myocardial ischaemia can be induced in humans with coronary artery disease when hypotension and tachycardia is permitted during isoflurane anaesthesia.


Isoflurane Halothane Coronary Sinus Enflurane Coronary Blood Flow 
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Copyright information

© Canadian Anesthesiologists 1988

Authors and Affiliations

  • John H. Tinker
    • 1
  1. 1.Department of AnesthesiaThe University of Iowa Hospitals and ClinicsIowa City

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