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PubMed · 2652973

Coronary vasomotion during anesthesia.

S Reiz
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Abstract

The incidence of perioperative myocardial ischemia and associated cardiac complications in patients with coronary artery disease (CAD) varies widely, as reported in the literature. Much of the confusion and contradictions surrounding this issue can be attributed to differences in populations studied, study protocols, and techniques employed to diagnose myocardial ischemia and infarction. Data obtained in recent years have indicated that a large proportion of intraoperative myocardial ischemic events are unrelated to hemodynamic aberrations. Coronary vasospasm and blood flow redistribution have both been suggested as important mechanisms for ischemia during anesthesia and surgery in patients with CAD. These findings challenge our concepts of how ischemia might be prevented by maintaining systemic hemodynamics within "normal limits". They also emphasize the importance of establishing new and more sensitive methods to detect myocardial ischemia in the operating room and recovery area. This paper focuses on myocardial ischemia related to coronary vasomotion during anesthesia and surgery.

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Anesthesia, GeneralCardiac Surgical ProceduresCoronary CirculationCoronary DiseaseCoronary VasospasmCoronary VesselsHumansIntraoperative PeriodIsofluraneVascular Surgical ProceduresJournal ArticleResearch Support, Non-U.S. Gov'tReview

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S Reiz. 1989. Coronary vasomotion during anesthesia.. https://pubmed.ncbi.nlm.nih.gov/2652973/

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Stereoselective pharmacokinetics of ketamine and norketamine after racemic ketamine or S-ketamine administration during isoflurane anaesthesia in Shetland ponies.

BACKGROUND: The arterial pharmacokinetics of ketamine and norketamine enantiomers after racemic ketamine or S-ketamine i.v. administration were evaluated in seven gelding ponies in a crossover study (2-month interval). METHODS: Anaesthesia was induced with isoflurane in oxygen via a face-mask and then maintained at each pony's individual MAC. Racemic ketamine (2.2 mg kg(-1)) or S-ketamine (1.1 mg kg(-1)) was injected in the right jugular vein. Blood samples were collected from the right carotid artery before and at 1, 2, 4, 8, 16, 32, 64, and 128 min after ketamine administration. Ketamine and norketamine enantiomer plasma concentrations were determined by capillary electrophoresis. Individual R-ketamine and S-ketamine concentration vs time curves were analysed by non-linear least square regression two-compartment model analysis using PCNonlin. Plasma disposition curves for R-norketamine and S-norketamine were described by estimating AUC, C(max), and T(max). Pulse rate (PR), respiratory rate (R(f)), tidal volume (V(T)), minute volume ventilation (V(E)), end-tidal partial pressure of carbon dioxide (PE'(CO(2))), and mean arterial blood pressure (MAP) were also evaluated. RESULTS: The pharmacokinetic parameters of S- and R-ketamine administered in the racemic mixture or S-ketamine administered separately did not differ significantly. Statistically significant higher AUC and C(max) were found for S-norketamine compared with R-norketamine in the racemic group. Overall, R(f), V(E), PE'(CO(2)), and MAP were significantly higher in the racemic group, whereas PR was higher in the S-ketamine group. CONCLUSIONS: Norketamine enantiomers showed different pharmacokinetic profiles after single i.v. administration of racemic ketamine in ponies anaesthetised with isoflurane in oxygen (1 MAC). Cardiopulmonary variables require further investigation.

Anesthesia, General↗