An Inhalation Anesthetic Technique is Preferable for Patients Undergoing Coronary Artery Bypass Grafting

  • Jan L. Kramer
  • David J. Wagner
  • Stephen J. Thomas


What is the “best” method for anesthetizing patients for coronary artery bypass graft (CABG) surgery? Is there a “best” method? The very low morbidity and mortality reported from many centers where different anesthetics are employed [1] would suggest that there is no ideal technique. Nevertheless, it appears that the reflex response of many anesthesiologists when confronted with a patient for CABG (or for that matter any patient with “severe” heart disease) is to reach for one of the potent intravenous narcotics. To give these drugs their due, the current popularity of high-dose narcotic techniques for CABG is, no doubt, based upon their safety, the “railroad track” hemodynamics [2, 3] that often accompany their administration, and their ease of use. In many centers, volatile anesthetics have been relegated to the occasional role of treating a bit of hypertension here and there. We feel this is simplistic, inappropriate, makes little use of the beneficial properties of the vapors, and is incredibly boring. Therefore the aim of this chapter is to discuss the rationale for selecting a volatile agent as the primary anesthetic for CABG patients. We hope to encourage the intelligent use of volatile drugs by describing their safety and efficacy in patients with coronary artery disease as well as delineating potential problems or difficulties with their use.


Coronary Blood Flow Volatile Anesthetic Myocardial Oxygen Consumption Coronary Perfusion Pressure Myocardial Oxygen Demand 
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  1. 1.
    Miller DC, Stinson EB, Oyer PE, et al.: Discriminant analysis of the changing risks of coronary artery operations: 1971–1979. J Thorac Cardiovasc Surg 85:197, 1983.PubMedGoogle Scholar
  2. 2.
    Delange S, Boscoe MJ, Stanley TH: Comparison of sufentanil-O2 and fentanyl-O2 for coronary artery surgery. Anesthesiology 56:112, 1982.CrossRefGoogle Scholar
  3. 3.
    Stanley TH, Webster LR: Anesthetic requirements and cardiovascular effects of fentanyl-O2 and fentanyl-diazepam-O2 anesthesia in man. Anesth Analg 57:411, 1978.PubMedGoogle Scholar
  4. 4.
    Slogoff S, Keats AS: Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 62:107, 1985.PubMedCrossRefGoogle Scholar
  5. 5.
    Slogoff S, Keats AS: Further observations on perioperative myocardial ischemia. Anesthesiology 65:539, 1986.PubMedCrossRefGoogle Scholar
  6. 6.
    Isom OW, Spencer FC, Feigenbaum H, Cunningham Jn Jr, Roe C: Prebypass myocardial damage in patients undergoing coronary revascularization: an unrecognized vulnerable period. Circulation [Suppl] 52:11–119, 1975.Google Scholar
  7. 7.
    Merin, RG, Lowenstein E, Gelman S: Is anesthesia beneficial for the ischemic heart? III. Anesthesiology 64:137, 1986.PubMedCrossRefGoogle Scholar
  8. 8.
    Bland JHL, Lowenstein E: Halothane induced decrease in experimental myocardial ischemia in the non-failing canine heart. Anesthesiology 45:287, 1976.PubMedCrossRefGoogle Scholar
  9. 9.
    Roizen MF, Hamilton WK, Yung JS: Treatment of stress-induced increases in pulmonary capillary wedge pressure using volatile anesthetics. Anesthesiology 55:446–450, 1981.PubMedCrossRefGoogle Scholar
  10. 10.
    Dole WP, Alexander GM, Campbell AB, Hixson EL, Bishop VS: Interpretation and physiological significance of diastolic coronary artery pressure-flow relationships in the canine coronary bed. Cir Res 55:215–226, 1984.Google Scholar
  11. 11.
    Lowenstein E, Foex P, Francis CM, Davies WL, Yusuf S, Ryder WA: Regional ischemic ventricular dysfunction in myocardium supplied by a narrowed coronary artery with increasing halothane concentration in the dog. Anesthesiology 55:349, 1981.PubMedCrossRefGoogle Scholar
  12. 12.
    Behrenbeck T, Nugent M, Quasha A, Hoffman E, Ritman E, Tinker J: Halothane and ischemic regional myocardial wall dynamics. Anesthesiology 53:5140, 1980.CrossRefGoogle Scholar
  13. 13.
    Buffington CW: Impaired systolic thickening associated with halothane in the presence of a coronary stenosis is mediated by changes in hemodynamics. Anesthesiology 64:632, 1986.PubMedCrossRefGoogle Scholar
  14. 14.
    Verrier ED, Edelist G, Consigny PM, Robinson S, Hotfman JIE: Greater coronary vascular reserve in dogs anestheticed with halothane. Anesthesiology 53:445–459, 1980.PubMedCrossRefGoogle Scholar
  15. 15.
    Merin RG: Are the myocardial functional and metabolic effects of isoflurane really different from those of halothane and enflurane? Anesthesiology 55:398, 1981.PubMedCrossRefGoogle Scholar
  16. 16.
    Sonntag H, Larsen R, Hilfiker O, Kettler D, Brockschnieder B: Myocardial blood flow and oxygen consumption during high dose fentanyl anesthesia in patients with coronary artery disease. Anesthesiology 56:417, 1982.PubMedCrossRefGoogle Scholar
  17. 17.
    Moffit EA, Scovil JE, Barker RA: Myocardial metabolism and hemodynamic response during high dose fentanyl anesthesia for coronary patients. Can Anaesth Soc J 31:611, 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Rao TLK, Jacobs KH, El-Etr AA: Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 58:499–505, 1983.CrossRefGoogle Scholar
  19. 19.
    Moffitt EA, Sethna DH: The coronary circulation and myocardial oxygenation in coronary artery disease: effects of anesthesia. Anesth Analg 65:395, 1986.PubMedGoogle Scholar
  20. 20.
    Moffitt EA, Sethna DH, Bussell JA, Raymond M, Matloff JM, Gray RJ: Myocardial metabolism and hemodynamic responses to halothane or morphine anesthesia for coronary artery surgery. Anesth Analg 61:979, 1982.PubMedCrossRefGoogle Scholar
  21. 21.
    Reiz S, Balfors E, Gustavsson B, Haggmark S, Nath S, Rydvall A, Truedsson H: Effects of halothane on coronary hemodynamics and ischemic heart disease and heart failure. Acta Anaesthesiol Scand 26:133, 1982.PubMedCrossRefGoogle Scholar
  22. 22.
    Delaney TJ, Kistner JR, Lake CL, Miller ED: Myocardial function during halothane and enflurane anesthesia in patients with coronary artery disease. Anesth Analg 59:240, 1980.PubMedGoogle Scholar
  23. 23.
    Moffit EA, Imrie DD, Scovil JE, Glenn JJ, Couisins CL, DelCampo C, Sullivan JA, Kinley CE: Myocardial metabolism and haemodynamic responses with enflurane anesthesia for coronary artery surgery. Can Anaesth Soc J 31:604, 1984.CrossRefGoogle Scholar
  24. 24.
    Rydvall A, Haggmark S, Nyhman H, Reiz S: Effects of enflurane on coronary hemodynamics in patients with ischemic heart disease. Acta Anaesthesiol Scand 28:690, 1984.PubMedCrossRefGoogle Scholar
  25. 25.
    Eger II EI: Isoflurane: a review. Anesthesiology 55:559, 1981.PubMedCrossRefGoogle Scholar
  26. 26.
    Gelman S, Fowler KC, Smith LR: Regional blood flow during isoflurane and halothane anesthesia. Acta Anaesthesiol Scand 63:557, 1984.Google Scholar
  27. 27.
    Reiz S, Balfors E, Sorensen MB, Ariola S, Friedman A, Truedsson H: Isoflurane: a powerful coronary vasodilator in patients with coronary artery disease. Anesthesiology 59:91, 1983.PubMedCrossRefGoogle Scholar
  28. 28.
    Moffit EA, Barker RA, Glenn JJ, Imrie DD, Delcampo C, Landymore RW, Kinley CE, Murphy DP: Myocardial metabolism and hemodynamic responses with isoflurane anesthesia for coronary arterial surgery. Anesth Analg 65:53, 1986.Google Scholar
  29. 29.
    Larsen R, Hilfiker O, Merkel G, Sonntag H, Drobnik L: Myocardial oxygen balance during enflurane and isoflurane anesthesia for coronary artery surgery [abstr]. Anesthesiology 61: A4, 1984.CrossRefGoogle Scholar
  30. 30.
    Tarnow J, Markschies-Horning A, Schulte-Sasse V: Isoflurane increases the tolerance to pacing induced myocardial ischemia. Anesthesiology 64:147, 1986.PubMedCrossRefGoogle Scholar
  31. 31.
    Smith JS, Cahalan MK, Benefiel DJ, Lurz FW, Lampe GH, Byrd BJ, Schiller NB, Yee ES, Turley K, Ullyot DJ, Hamilton WR: Fentanyl versus fentanyl-isoflurane in patients with impaired left ventricular function, [abstr]. Anesthesiology 63:A3, 1985.CrossRefGoogle Scholar
  32. 32.
    Buffington CW, Romson JL, Leven A, Duttlinger NC, Huang AW: Isoflurane induces coronary steal in a canine model of chronic coronary occlusion. Anesthesiology 66:280, 1987.PubMedCrossRefGoogle Scholar
  33. 33.
    Sill JC, Bove AA, Nugent M, Blaise GA, Dewey JD, Griban C: Effects of isoflurane on coronary arteries and coronary arterioles in the dog. Anesthesiology 66:262, 1987.CrossRefGoogle Scholar
  34. 34.
    Becker LC: Is isoflurane dangerous for the patient with coronary artery disease? Anesthesiology 66:259, 1987.PubMedCrossRefGoogle Scholar
  35. 35.
    Lichtenthal PR, Wade LD, Niemyski R, Shapiro BA: Respiratory management after cardiac surgery with inhalation anesthesia. Crit Care Med 11:603, 1983.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers, Boston 1988

Authors and Affiliations

  • Jan L. Kramer
  • David J. Wagner
  • Stephen J. Thomas

There are no affiliations available

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