British Journal of Anaesthesia, Vol 79, Issue 1 68-77, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
V. Piriou, S. Ross, D. Pigott, R. Evans and P. Foex
In common with halogenated anaesthetics, nicorandil, a new KATP channel
opener, has been shown to have cardioprotective and vasodilator effects.
Recent studies have also suggested that the vasodilator and protective
effects of halogenated anaesthetics are mediated partly via KATP channel
opening. This study examined the effects of concurrent administration of
nicorandil and isoflurane on haemodynamic state and ventricular function
before, during and after 15 min of ischaemia. We studied left ventricular
function in 40 anaesthetized rabbits using ultrasonomicrometry.
Measurements were obtained before, during and after 15 min of regional
ischaemia. Regional ventricular function was assessed in terms of systolic
shortening (SS%) and preload recruitable work area (PRWA, the area beneath
the regional stroke work vs end- diastolic length relationship) during
reperfusion. Four groups were studied: group F (n = 10) received a bolus
dose of fentanyl 100 micrograms kg-1 and then 400 micrograms kg-1 h-1
throughout; group 1 (n = 10) received 2.05% end-tidal concentration of
isoflurane (1 MAC); group FN (n = 10) received fentanyl, a bolus does of
nicorandil 100 micrograms kg-1 and then 25 micrograms kg-1 min-1, 15 min
before occlusion; and group IN (n = 10) received isoflurane and nicorandil.
Isoflurane decreased left ventricular systolic pressure and ventricular
contractility (+dP/dtmax, slope of preload recruitable stroke work, and
SS%). Nicorandil increased -dP/dtmax in group FN. Post-ischaemic regional
left ventricular contractility in group I did not differ from that in group
F, however, groups receiving nicorandil recovered to a greater extent.
Group IN showed better recovery compared with all other groups when
ventricular contractility was assessed by PRWA normalized to pre-occlusion
values (mean 99.3 (SEM 10.5)% vs 73.4 (7.5)%, 50.2 (5.8)% and 52.4 (3.7)%
at 120 min reperfusion in groups FN, I and F, respectively). Tissue ATP and
lactate contents did not differ between groups. We conclude that concurrent
administration of nicorandil and isoflurane enhanced post-ischaemic
recovery compared with isoflurane anaesthesia or nicorandil and fentanyl
administration.
LABORATORY INVESTIGATIONS
Beneficial effect of concomitant administration of isoflurane and nicorandil
Hopital Cardio-Vasculaire Louis Pradel, Departement d'Anesthesie Reanimation, B16, 28 Avenue Doyen Lepine, 69 500 Lyon Bron, France; Nuffield Department of Anaesthetics, The Radcliffe Infirmary, Oxford OX2 6HE
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