Isoflurane and halothane attenuate endothelium-dependent vasodilation in rat coronary microvessels

Vascular aging and hemodynamic stability in the intraoperative period

The proportion of elderly people in the population is steadily increasing, and the inevitable consequence is that this subpopulation is more frequently represented in common medical procedures and surgeries. Understanding the circulatory changes that accompany the aging process is therefore becoming increasingly timely and relevant. In this short review, we discuss aspects of vascular control in aging that are particularly relevant in the maintenance of intraoperative hemodynamic stability. We subsequently review the effects of certain notable anesthetic agents with respect to the aging vasculature.

Radio frequency heating at 9.4T (400.2 MHz): in vivo thermoregulatory temperature response in swine

In vivo thermoregulatory temperature response to radio frequency (RF) heating at 9.4T was studied by measuring temperatures in nine anesthetized swine. Temperatures were measured in the scalp, brain, and rectum. The RF energy was deposited using a four-loop head coil tuned to 400.2 MHz. Sham RF was delivered to three swine to understand the thermal effects of anesthesia (animal weight = 54.16 kg, SD = 3.08 kg). Continuous wave (CW) RF energy was delivered to the other six animals for 2.5-3.4 h (animal weight = 74.01 +/- 26.0 kg, heating duration = 3.05 +/- 0.29 h). The whole-head specific absorption rate (SAR) varied between 2.71 W/kg and 3.20 W/kg (SAR = 2.93 +/- 0.18 W/kg). Anesthesia caused the brain and rectal temperatures to drop linearly. Altered thermoregulatory response was detected by comparing the difference in the temperature slopes before and after the RF delivery from zero. RF heating statistically significantly altered the rate of cooling down of the animal. The temperature slope changes correlated well with the RF energy per unit head weight and heating duration, and the maximum rectal temperature change during heating in heated animals. The temperature slope changes did not correlate well to the whole-head average SARs.

The volatile anesthetic isoflurane inhibits the histamine-induced Ca2+ influx in primary human endothelial cells

Although isoflurane is a known vasodilator, the mechanism of isoflurane-induced vasodilation is not clear. One of the most important systems in this context is the nitric oxide (NO)-mediated vasodilation. The activity of this system is regulated by the agonist-induced Ca(2+) influx rather than Ca(2+) release from internal stores. A number of reports have studied the effect of volatile anesthetics on the cytoplasmic calcium concentration signaling in mammalian endothelial cells. However, similar studies using human endothelial cells are lacking. In this study, therefore, we investigated whether isoflurane affects the histamine-induced Ca(2+) influx in primary cultures of human endothelial cells. Using confocal laser scanning microscopy and cells loaded with the Ca(2+) indicator Fluo-3, we studied the effect of isoflurane on the plateau phase of the histamine-induced Ca(2+) influx, which is considered to be due to capacitative Ca(2+) entry. In addition, we measured the ion flux through capacitative Ca(2+) channels directly by using Mn(2+) ions, which, on entering the cell, quench the Fura-2 fluorescence. The results of these two methods were in close agreement and showed a dose-dependent inhibition of the capacitative Ca(2+) entry by isoflurane. Isoflurane apparently depresses NO-mediated vasodilation when the observed inhibition is not compensated for downstream of the endothelial NO synthase activation.

IMPLICATIONS

In response to vasoactive agents, endothelial cells produce nitric oxide (NO), which relaxes the underlying smooth muscle cells. Inhaled anesthetics inhibit this system by an unknown mechanism. Using primary human endothelial cells, we showed that the anesthetic isoflurane depresses a Ca(2+) influx, which is responsible for the activation of the endothelial NO synthase.

Effect of isoflurane on skin-pressure-induced vasodilation

Since general anesthesia has been shown to attenuate endothelium-dependent vasodilation, it was of interest to verify whether general anesthesia would modify skin vasodilation in response to local pressure application, which is endothelium dependent. To study the effect of general anesthesia on pressure-induced vasodilation development, we examined the effects of low- and high-dose isoflurane. Skin blood flow was measured by laser Doppler flowmetry during 11.1 Pa s(-1) increases in locally applied pressure in anesthetized rats treated with low or high doses of isoflurane. Following the administration of low doses of isoflurane, skin blood flow increased from baseline, with increasing local pressure application (+37 +/- 10% at 2.0 kPa). The increase in skin blood flow was absent in rats treated with high doses (-20 +/- 5% at 2.0 kPa), even when the anesthesia-induced hypotension was corrected by gelofusine infusion (-20 +/- 10% at 2.0 kPa). Whereas sodium-nitroprusside-induced vasodilation developed following low and high doses of isoflurane, acetylcholine-induced vasodilation was impaired with high doses compared to low doses. These data show that pressure-induced vasodilation is abolished with high doses of anesthetics. It is not the anesthesia-induced hypotension, but the depth of anesthesia, which can lead to the disappearance of pressure-induced vasodilation by an alteration in endothelial function.