Halothane depression of myocardial slow action potentials

The Effects of General Anesthetics on Synaptic Transmission

General anesthetics are a class of drugs that target the central nervous system and are widely used for various medical procedures. General anesthetics produce many behavioral changes required for clinical intervention, including amnesia, hypnosis, analgesia, and immobility; while they may also induce side effects like respiration and cardiovascular depressions. Understanding the mechanism of general anesthesia is essential for the development of selective general anesthetics which can preserve wanted pharmacological actions and exclude the side effects and underlying neural toxicities. However, the exact mechanism of how general anesthetics work is still elusive. Various molecular targets have been identified as specific targets for general anesthetics. Among these molecular targets, ion channels are the most principal category, including ligand-gated ionotropic receptors like γ-aminobutyric acid, glutamate and acetylcholine receptors, voltage-gated ion channels like voltage-gated sodium channel, calcium channel and potassium channels, and some second massager coupled channels. For neural functions of the central nervous system, synaptic transmission is the main procedure for which information is transmitted between neurons through brain regions, and intact synaptic function is fundamentally important for almost all the nervous functions, including consciousness, memory, and cognition. Therefore, it is important to understand the effects of general anesthetics on synaptic transmission via modulations of specific ion channels and relevant molecular targets, which can lead to the development of safer general anesthetics with selective actions. The present review will summarize the effects of various general anesthetics on synaptic transmissions and plasticity.

Isoflurane Inhibits Dopaminergic Synaptic Vesicle Exocytosis Coupled to CaV2.1 and CaV2.2 in Rat Midbrain Neurons

Volatile anesthetics affect neuronal signaling by poorly understood mechanisms. Activation of central dopaminergic pathways has been implicated in emergence from general anesthesia. The volatile anesthetic isoflurane differentially inhibits glutamatergic and GABAergic synaptic vesicle (SV) exocytosis by reducing presynaptic Ca²⁺ influx without affecting the Ca²⁺-exocytosis relationship, but its effects on dopaminergic exocytosis are unclear. We tested the hypothesis that isoflurane inhibits exocytosis in dopaminergic neurons. We used electrical stimulation or depolarization by elevated extracellular KCl to evoke exocytosis measured by quantitative live-cell fluorescence imaging in cultured rat ventral tegmental area neurons. Using trains of electrically evoked action potentials (APs), isoflurane inhibited exocytosis in dopaminergic neurons to a greater extent (30 ± 4% inhibition; p < 0.0001) than in non-dopaminergic neurons (15 ± 5% inhibition; p = 0.014). Isoflurane also inhibited exocytosis evoked by elevated KCl in dopaminergic neurons (35 ± 6% inhibition; p = 0.0007), but not in non-dopaminergic neurons (2 ± 4% inhibition). Pharmacological isolation of presynaptic Ca²⁺ channel subtypes showed that isoflurane inhibited KCl-evoked exocytosis mediated exclusively by either Ca_V2.1 (P/Q-type Ca²⁺ channels; 30 ± 5% inhibition; p = 0.0002) or by Ca_V2.2 (N-type Ca²⁺ channels; 35 ± 11% inhibition; p = 0.015). Additionally, isoflurane inhibited single AP-evoked Ca²⁺ influx by 41 ± 3% and single AP-evoked exocytosis by 34 ± 6%. Comparable reductions in exocytosis and Ca²⁺ influx were produced by lowering extracellular [Ca²⁺]. Thus, isoflurane inhibits exocytosis from dopaminergic neurons by a mechanism distinct from that in non-dopaminergic neurons involving reduced Ca²⁺ entry through Ca_V2.1 and/or Ca_V2.2.

Halothane and sevoflurane inhibit Na/Ca exchange current in rat ventricular myocytes

BACKGROUND

The electrogenic Na+/Ca2+ exchanger (NCX) represents the main extrusion pathway for Ca2+ in ventricular muscle and therefore plays an important role in the regulation of cytosolic Ca2+ and contraction. Halothane and sevoflurane modulate cytosolic Ca2+ regulation and at steady state are negatively inotropic, however, the involvement of anaesthetic-induced changes in NCX activity in these effects requires further study.

METHODS

Ventricular myocytes were isolated using a standard collagenase/protease dispersion technique and superfused with a physiological salt solution at 30 degrees C. Whole-cell patch-clamp technique was used to control membrane voltage. I(NCX) (identified as Ni2+ sensitive current) was recorded using a ramp clamp protocol under conditions to inhibit contaminating currents.

RESULTS

With 0.6 mM sevoflurane, outward I(NCX) at positive voltages (> or = 0 mV) and inward I(NCX) at voltages negative to -60 mV was significantly reduced (P<0.05, n=13; I(NCX) reduced by 48% at +50 and 65% of control at -120 mV). Halothane (0.6 mM) inhibited outward I(NCX) at voltages positive to -10 mV and inward I(NCX) at voltages negative to -80 mV (P<0.05, n=10; I(NCX) reduced by 64% at +50 and 65% of control at -120 mV). Anaesthetic-induced inhibition of both inward and outward current was not voltage-dependent.

CONCLUSIONS

Inhibition of Ca2+ efflux via NCX (i.e. inward I(NCX)) during an exposure to halothane or sevoflurane would be expected to limit the negative inotropic effects of these agents and help maintain SR Ca2+ content.

Contrasting anesthetic sensitivities of T-type Ca2+ channels of reticular thalamic neurons and recombinant Ca(v)3.3 channels

Reticular thalamocortical neurons express a slowly inactivating T-type Ca(2+) current that is quite similar to that recorded from recombinant Ca(v)3.3b (alpha1Ib) channels. These neurons also express abundant Ca(v)3.3 mRNA, suggesting that it underlies the native current. Here, we test this hypothesis by comparing the anesthetic sensitivities of recombinant Ca(v)3.3b channels stably expressed in HEK 293 cells to native T channels in reticular thalamic neurons (nRT) from brain slices of young rats. Barbiturates completely blocked both Ca(v)3.3 and nRT currents, with pentobarbital being about twice more potent in blocking Ca(v)3.3 currents. Isoflurane had about the same potency in blocking Ca(v)3.3 and nRT currents, but enflurane, etomidate, propofol, and ethanol exhibited 2-4 fold higher potency in blocking nRT vs Ca(v)3.3 currents. Nitrous oxide (N(2)O; laughing gas) blocked completely nRT currents with IC(50) of 20%, but did not significantly affect Ca(v)3.3 currents at four-fold higher concentrations. In addition, we observed that in lower concentration, N(2)O reversibly increased nRT but not Ca(v)3.3 currents. In conclusion, contrasting anesthetic sensitivities of Ca(v)3.3 and nRT T-type Ca(2+) channels strongly suggest that different molecular structures of Ca(2+) channels give rise to slowly inactivating T-type Ca(2+) currents. Furthermore, effects of volatile anesthetics and ethanol on slowly inactivating T-type Ca(2+) channel variants may contribute to the clinical effects of these agents.

Effects of halothane on contraction and intracellular calcium in ventricular myocytes from streptozotocin-induced diabetic rats

BACKGROUND

Some of the cellular targets affected by volatile anaesthetics (e.g. halothane) which contribute to the negative inotropic effects of these agents are also affected during the progression of diabetic cardiomyopathy. A previous report suggested that halothane inhibited contraction to a lesser extent in papillary muscle from diabetic animals and so the aim of this study was to investigate possible mechanisms underlying this effect.

METHODS

Contractility and cytosolic calcium ion (Ca(2+)) transients were measured (fura-2) in ventricular myocytes isolated from control and streptozotocin (STZ)-induced diabetic rats in the absence and presence of halothane 0.6 mmol litre(-1) at 1 Hz stimulation. Sarcoplasmic reticulum (SR) Ca(2+) content was assessed by rapid application of caffeine. All experiments were carried out at 36-37 degrees C.

RESULTS

The amplitude of shortening, the electrically evoked Ca(2+) transient, SR Ca(2+) content and myofilament Ca(2+) sensitivity, though not altered by STZ treatment, were significantly reduced by halothane to a similar extent in control and STZ myocytes. The time course of contraction and Ca(2+) transient were prolonged in myocytes from STZ-treated rats compared with controls but this was not altered further by halothane. STZ treatment appeared to reduce Ca(2+) efflux from the cell, an effect reversed by halothane.

CONCLUSIONS

In contrast to a previous report, we could find no evidence of amelioration of the negative inotropic effect of halothane in myocytes from the STZ-induced diabetic rat. Contractility, the cytosolic Ca(2+) transient, SR Ca(2+) content and myofilament Ca(2+) sensitivity were qualitatively similar in control and STZ myocytes and were all depressed to the same extent by halothane.

Calcium channels--basic aspects of their structure, function and gene encoding; anesthetic action on the channels--a review

PURPOSE

To review recent findings concerning Ca(2+) channel subtype/structure/function from electrophysiological and molecular biological studies and to explain Ca(2+) channel diseases and the actions of anesthetics on Ca(2+) channels.

SOURCE

The information was obtained from articles published recently and from our published work.

PRINCIPAL FINDINGS

Voltage-dependent Ca(2+) channels serve as one of the important mechanisms for Ca(2+) influx into the cells, enabling the regulation of intracellular concentration of free Ca(2+). Recent advances both in electrophysiology and in molecular biology have made it possible to observe channel activity directly and to investigate channel functions at molecular levels. The Ca(2+) channel can be divided into subtypes according to electrophysiological characteristics, and each subtype has its own gene. The L-type Ca(2+) channel is the target of a large number of clinically important drugs, especially dihydropyridines, and binding sites of Ca(2+) antagonists have been clarified. The effects of various kinds of anesthetics in a variety of cell types have been demonstrated, and some clinical effects of anesthetics can be explained by the effects on Ca(2+) channels. It has recently become apparent that some hereditary diseases such as hypokalemic periodic paralysis result from calcium channelopathies.

CONCLUSION

Recent advances both in electrophysiology and in molecular biology have made it possible to clarify the Ca(2+) channel structures, functions, genes, and the anesthetic actions on the channels in detail. The effects of anesthetics on the Ca(2+) channels either of patients with hereditary channelopathies or using gene mutation techniques are left to be discovered.

Volatile anesthetic inhibition of neuronal Ca channel currents expressed in Xenopus oocytes

The genes encoding the alpha(1A), alpha(1B), alpha(1C) and alpha(1E) subunits of neuronal high voltage-gated Ca channels (HVGCCs) were separately expressed with beta(1B) and alpha(2)/delta subunits in Xenopus oocytes to determine the effects of volatile anesthetics (VAs) on currents through each specific channel. VA effects were determined on currents carried by Ba(2+) (I(Ba)) using the two electrode voltage clamp technique. Although time to peak was unaffected, both halothane (0.59 mM) and isoflurane (0.70 mM) reversibly inhibited peak I(Ba) by 25-35% and late current (at 830 ms) by 50-60%. A hyperpolarizing shift in steady-state inactivation of alpha(1E)-current was found which could contribute up to one third of observed decrease in the peak current. The rate of inactivation of I(Ba) seen with alpha(1A), alpha(1B) and alpha(1E)-type Ca channels was consistently increased by halothane and isoflurane. To more clearly quantify these effects, I(Ba) inactivation was fit by a single exponential function. The anesthetics depressed both the inactivating and non-inactivating residual components of I(Ba) and decreased the time constant of inactivation. In the case of I(Ba) through alpha(1C)-type channels, inactivation was minimal; however, the average current was inhibited by VAs. Similar inhibition of all these HVGCCs by halothane and isoflurane suggests that a common structural component may be involved. Furthermore, the inhibition of such neuronal HVGCCs in situ could alter synaptic neurotransmitter release and contribute to the anesthetic state.

Anesthetic modulation of myocardial ischemia and reperfusion injury in pigs: comparison between halothane and sevoflurane

PURPOSE

Halothane offers protection against the reperfusion injury of the myocardium. This study compared sevoflurane with halothane in its potential to modulate the effects of acute severe ischemia and reperfusion on the myocardium.

METHODS

Experiments were conducted on 25 pigs. Anesthesia consisted of thiopental, vecuronium and fentanyl. The lungs were mechanically ventilated with oxygen and nitrogen. Animals were randomly allocated to receive either I MAC halothane or sevoflurane. A control group received fentanyl and pentobarbital. Regional myocardial function was measured with sonomicrometers. The left anterior descending coronary artery was occluded for 15 min followed by 60 min reperfusion.

RESULTS

Neither halothane nor sevoflurane protected the heart against the effects of acute and severe regional myocardial ischemia. During reperfusion, 89% of the animals receiving sevoflurane suffered from ventricular fibrillation compared with 30% in the halothane group (P < 0.005). Five minutes into the reperfusion period the animals subjected to halothane anesthesia demonstrated an 88% recovery in regional myocardial systolic function while in the sevoflurane group the recovery was 40% of pre-ischemic control (P < 0.05).

CONCLUSION

Halothane is associated with less reperfusion arrhythmias and, in addition, recovery of regional myocardial function during reperfusion was more rapid in the presence of halothane than with sevoflurane.

A comparison of the effects of fentanyl and propofol on left ventricular contractility during myocardial stunning

BACKGROUND

The intravenous anaesthetic propofol has been shown to possess free radical scavenging activity and calcium channel blocking effects in a number of in vitro models. We decided to compare the effects of propofol with those of fentanyl on myocardial contractility during and after ischaemia to determine whether propofol could protect the heart and improve recovery of ventricular contractile function in open-chested dogs.

METHODS

Twenty adult beagles were acutely instrumented, under halothane anaesthesia, to measure ECG; aortic, left ventricular pressures; cardiac output; coronary flow; and segmental lengths in the regions perfused by the left anterior and left circumflex coronary arteries. After surgery and a stabilisation period halothane anaesthesia was terminated and fentanyl (100 microg x kg[-1] bolus followed by 2 microg x kg[-1] x min[-1] infusion; n=10) or propofol (5 mg x kg[-1] bolus followed by 0.3 mg x kg[-1] x min[-1] infusion; n=10) anaesthesia commenced. After a stabilisation period the LAD coronary artery was occluded for 10 min and then reperfused for 3 h. Measurements were taken throughout the protocol.

RESULTS

We found no significant difference in recovery of contractile function between propofol and fentanyl as assessed by normalised preload recruitable work area (50+/-10 vs 47+/-16%), normalised systolic shortening (36+/-12 vs 48+/-14%) and peak left ventricular dP/dt (1665+/-276 vs 1846+/-151 mmHg x s[-1]) at the end of reperfusion.

CONCLUSION

We conclude that at the concentration used in this study propofol shows no improvement in contractility during "stunning" when compared to fentanyl.

Propofol induces a lowering of free cytosolic calcium in myocardial cells

BACKGROUND

The intravenous anaesthetic drug propofol has been shown to depress myocardial contractility. Ketamine, on the other hand, is a well-documented cardiovascular stimulant. These differences could possibly be due to different effects of the drugs on the calcium homeostasis of the myocardium.

METHODS

The fluorescent intracellular probe fura-2 acetoxymethyl ester (fura-2/AM) was used in this in vitro investigation to study the influence of intravenous anaesthetic drugs on free cytosolic calcium concentration in suspensions of isolated rat myocardial cells.

RESULTS

Addition of 0.5-2.0 micrograms/mL propofol resulted in a significant and dose-dependent decrease of free cytosolic calcium concentration in the myocardial cells, while addition of 0.25-2.5 micrograms/mL ketamine did not affect this concentration significantly.

CONCLUSION

The results imply that the previously demonstrated negative inotropic effect of propofol could possibly be related to its influence on calcium availability in the myocardium.

Halothane and isoflurane preferentially depress a slowly inactivating component of Ca2+ channel current in guinea-pig myocytes

1. The effects of the inhalational anaesthetics halothane and isoflurane on the high-voltage-activated Ca2+ channels were determined in isolated guinea-pig ventricular myocytes using the patch-clamp technique. 2. Recording solutions were equilibrated with inhalational anaesthetic vapour delivered from a calibrated vaporizer set at clinically relevant ranges of partial pressure. Anaesthetic concentrations in solution were determined using gas chromatography. 3. Halothane (0.9 mM in solution) and isoflurane (0.8 mM in solution) decreased peak whole-cell CA2+ current (ICa) by approximately 40 and approximately 20%, respectively, while increasing the apparent rate of inactivation. 4. The sum of fast and slow exponential decay functions was required to fit the inactivation phase of ICa. The anaesthetics preferentially affected the slow component of inactivation while also increasing the rate of slow inactivation. The physiological significance of these effects was addressed by examining ICa evoked by a ventricular action potential waveform. 5. Measurement of the current carried by Ba2+ through Ca2+ channels (IBa) permitted the isolation of the slow component of inactivation. Halothane and isoflurane diminished peak IBa at 0 mV by approximately 45 and approximately 20% respectively, with similar changes in rate and magnitude of the slowly inactivating component as with ICa. 6. Cell-attached patch-clamp measurements of Ca2+ channel activity revealed that halothane did not alter single-channel conductance. Instead, the anaesthetic reduced channel open probability to the same extent as observed during the whole-cell recording, an effect partially due to an increase in null sweeps. In patches with a single channel present, the open-time distribution, fitted by a single exponential, showed a decrease in mean open time. The closed-time distribution, fitted by the sum of slow and fast exponential components, revealed an anaesthetic-induced increase in the duration of the slow component with no effect on the fast component. Results are presented in terms of a channel-gating model, and model predictions are examined with a computer simulation.

Cardiovascular effects of 1.0, 1.5, and 2.0 minimum alveolar concentrations of isoflurane in experimentally induced hypothyroidism in dogs

This study was performed to determine the cardiovascular responses to isoflurane in euthyroid and hypothyroid dogs. Four healthy mixed-breed dogs were studied prior to thyroidectomy (PRE), 6 months after thyroidectomy (HYP), and after 2 months of oral supplementation with 1-thyroxine (SUP). Heart rate (HR), cardiac output (Q), stroke volume (SV), systolic, diastolic, mean arterial blood pressure (SAP, DAP, MAP), and total peripheral resistance (TPR) were determined in awake dogs and in the same dogs when end-tidal isoflurane concentration were 1.28%, 1.92%, and 2.56%. Ventilation was controlled in anesthetized dogs and PACO2 maintained between 38 to 42 mm Hg. Isoflurane caused significant (P < .05) dose-dependent reduction in Q, SV, SAP, DAP, and MAP in the PRE, HYP, and SUP dogs. Cardiac output was lower in the HYP dogs than in the PRE or SUP dogs during awake measurement. TPR was increased in the awake HYP dogs compared with the PRE or SUP dogs. During anesthesia, HYP dogs tended to have lower Q, SV, SAP, and MAP PRE or SUP groups, but the only significant reduction was SAP during 1.5 MAC. The cardiovascular responses to isoflurane in hypothyroid dogs are similar to euthyroid animals with a dose-dependent depression in Q, SV, and arterial pressure.

Effects of halothane on calcium(2+)-activated tension of the contractile proteins and calcium(2+) uptake and release by the sarcoplasmic reticulum in skinned human myocardial fibers

Based on studies using skinned myocardial fibers from animals, it has been postulated that one of the major mechanisms by which halothane depresses myocardial contractility is by decreasing the Ca2+ content of the sarcoplasmic reticulum (SR). In this study we examined, in skinned human myocardial fibers, the effects of halothane on Ca(2+)-activated tension development of the contractile proteins and Ca2+ uptake and release by the SR. Left ventricular muscle samples obtained from patients undergoing aortocoronary bypass operations were mechanically skinned and immersed in test solutions equilibrated with N2 and halothane preceded and followed by immersion in control solution (no halothane). To study Ca(2+)-activated tension development of the contractile proteins, free Ca2+ concentrations in the bathing solutions were buffered by EGTA. To study Ca2+ uptake and release by the SR, Ca2+ was loaded into the SR and released with caffeine and the resulting tension transients were measured. Halothane (1%-3%) depressed maximum Ca(2+)-activated tensions (pCa = -log[Ca2+](M) = 3.8) by 5% for each 1% increase in concentration. Tensions generated by submaximum Ca2+ concentrations expressed as a percentage of maximum tension were not significantly decreased by halothane except at 3%. Halothane decreased Ca2+ uptake (IC50 = 1.7%), and increased (by approximately 50%) Ca2+ release by the SR. We conclude that decreased activation of the contractile proteins and Ca2+ uptake by the SR can both contribute to the myocardial depression produced by halothane. Of these, decreased Ca2+ uptake by the SR is probably a major mechanism for halothane depression of myocardium.

Fatal myocardial depression and circulatory collapse associated with complement activation induced by plasma infusion in severe porcine sepsis

We have previously reported that fresh frozen plasma (FFP) may induce a rapid irreversible shock when repeatedly infused in pigs challenged with Gram-negative sepsis. The aims of the present study were to elucidate the cardiovascular nature of the shock and determine the aetiologic role of tumour necrosis factor (TNF), complement activation and halothane anaesthesia. Three groups of anaesthetized piglets were inoculated with a lethal dose of live E. coli bacteria. Groups I (n = 8) and III (n = 8) were anaesthetized with halothane and group II (n = 8) with ketamine. Animals in groups I and II received repeated infusions of FFP, whereas animals in group III received repeated infusions of 7% albumin. Six animals in group I and four animals in group II died during the first plasma infusion. Survival time was significantly longer in group II (P = 0.04) compared to group I. No animals in group III died during the albumin infusions, and no adverse effects were observed during the infusions. In group I the plasma induced shock was characterized by abruptly falling mean arterial pressure, cardiac index, systemic vascular resistance index and left ventricular contractility. Concomitant increases were recorded in left ventricular filling pressure and central venous pressure. Group II demonstrated a similar, but delayed response. Plasma infusion was associated with a significant increase in terminal complement complex (TCC) (P < 0.03 in group I, P < 0.05 in group II) and depletion of serum ionized calcium. We conclude that FFP may induce fatal myocardial depression and circulatory collapse in severe sepsis. Complement activation may be of aetiologic importance.

Anesthetic alteration of ryanodine binding by cardiac calcium release channels

Differential cardiac contractile depression by volatile anesthetics is well documented, and evidence points to differing actions on the myocardial sarcoplasmic reticulum (SR). Since the Ca(2+)-release channel (CaRC) of the SR binds ryanodine with high-affinity when opened by micromolar Ca2+ concentrations, ryanodine binding to cardiac SR membrane vesicles was employed as an assay of anesthetic modulation of CaRC activity. Canine ventricle was homogenized, centrifuged preparatively and then differentially on a sucrose gradient. A fraction enriched with CaRCs was defined by: the presence of a approximately 450 kDa protein consistent with CaRC; approximately 3-fold enhancement of vesicular 45Ca2+ uptake by ruthenium red; Ca(2+)-activated [3H]ryanodine binding. Specific binding of 10 nM ryanodine was activated by > 0.5 microM Ca2+ and was maximal at approximately 6 pmol/mg protein in > or = 20 microM Ca2+. Halothane (1.5%), but not isoflurane, shifted the Ca(2+)-dependence of ryanodine binding to lower [Ca2+]. With submaximal activation by 5 microM Ca2+, 1.5% and 0.75% halothane enhanced binding of 10-80 microM ryanodine, while 2.5% isoflurane and 3.5% enflurane did not. A plot of bound/free vs. bound ryanodine suggests that halothane causes a dose-dependent increase in ryanodine binding to a high-affinity site, while isoflurane has no such action. In intact myocardium, this effect will decrease Ca2+ retention in the SR so that less Ca2+ will be available to activate contractions, consistent with halothane's depressant action.

Effects of volatile anesthetics, enflurane, isoflurane, and halothane on ventricular delayed activation in a canine myocardial infarction model

The authors examined the effects of volatile anesthetics (enflurane, isoflurane, and halothane) on ventricular activation in a canine myocardial infarction model. Enflurane at 1 minimum aveolar concentration further delayed or blocked delayed activation in the infarcted zones with only slight effects on activation of the normal zones. Halothane showed similar and comparable effects on ventricular activation to those of enflurane. Although isoflurane also showed similar effects, they were of a lesser extent. Enflurane and halothane, but not isoflurane, inhibited ventricular stimulation-induced arrhythmias. Thus, enflurane and halothane produced marked depression of delayed activation in myocardial infarction, which may affect, that is, inhibit or provoke, ventricular arrhythmias in myocardial infarction.

Cardiac electrophysiology and conduction pathway ablation

Invasive cardiac electrophysiological (EP) testing and transcatheter ablation are new methods available for the diagnosis and treatment of complex dysrhythmias. The purpose of this review is to familiarize anaesthetists with these procedures. The information presented combines a literature review with the authors' experience. This article reviews normal cardiac conduction, tachycardia pathogenesis, principles of cardiac EP study and techniques of conduction pathway ablation. The anaesthetic considerations, including the choice of anaesthetic agent, monitoring problems, drug interactions, special methods of dysrhythmia termination in the EP lab, and complications specific to these procedures, are detailed. Balanced general anaesthesia or monitored anaesthesia care (MAC) sedation with benzodiazepines, propofol and narcotics are acceptable. Several conclusions can be drawn: transcatheter ablation is an effective treatment for many reentry tachycardias; anaesthetic assistance for this procedure will increasingly be needed; anaesthesia can easily be provided without influencing accurate EP testing; overdrive pacing is the method of choice for terminating tachydysrhythmias in the EP lab.

Hemodynamic interactions when combining verapamil, acute changes in extracellular ionized calcium concentration and enflurane, halothane or isoflurane in chronically instrumented dogs

To assess the hemodynamic interactions when combining verapamil, acute changes in extracellular ionized calcium concentration [Ca2+] and enflurane (2.5%), halothane (1.2%) or isoflurane (1.6%), seven dogs were chronically instrumented to measure heart rate (HR), aortic, left atrial and left ventricular (LV) pressures, and cardiac output (CO). [Ca2+] was lowered 0.35 mmol.l-1 by citrate infusion and then increased 0.35 mmol.l-1 above control level by CaCl2 infusions. Verapamil was infused at 3 micrograms.kg-1 x min-1 (loading dose 200 (awake), 150 (isoflurane) or 100 (enflurane and halothane) micrograms.kg-1), giving mean verapamil concentrations around 75 (range of means: 66-84 ng.ml-1). Verapamil produced mostly minor changes in the cardiovascular effects of changing [Ca2+] in both awake and anesthetized dogs, indicating mostly additive effects. Verapamil induced a decrease in HR at high [Ca2+] and abolished an increase in mean aortic pressure at both low and high [Ca2+] awake. Verapamil exaggerated the decrease in CO and stroke volume (SV) induced by low [Ca2+] during enflurane anesthesia and abolished the increase in CO induced by low [Ca2+] and exaggerated the increase in SV and LV dP/dtmax induced by high [Ca2+] during halothane anesthesia.

Alfentanil-midazolam anaesthesia has no electrophysiological effects upon the normal conduction system or accessory pathways in patients with Wolff-Parkinson-White syndrome

The effects of alfentanil-midazolam anaesthesia upon the electrophysiologic (EP) properties of normal atrioventricular (A-V) and accessory pathway (AP) conduction were studied in eight patients with Wolff-Parkinson-White syndrome during accessory pathway surgical ablation. The presence of an AP was confirmed by preoperative EP studies. Anaesthesia was induced with alfentanil (50 micrograms.kg-1) and midazolam (0.15 mg.kg-1) and maintained with an alfentanil infusion (2 micrograms.kg-1.min-1) and intermittent boluses of midazolam (1-2 mg q 15 min, PRN). Following sternotomy, a baseline EP study was performed which consisted of effective refractory period (ERP) and shortest cycle length (SCC) measurement during antegrade conduction in the AV and AP, as well as during retrograde conduction in the AP. Comparison with preoperative EP studies indicated that the administration of alfentanil-midazolam anaesthesia had no effect upon conduction or ERP in either pathway. Haemodynamic stability occurred throughout the surgical procedure with no tachyarrhythmias. We conclude that a combination of alfentanil-midazolam is suitable for general anaesthesia in patients undergoing ablative procedures for accessory pathways.

Effects of thiopental and halothane on spontaneous contractile activity induced in isolated ventricular muscles of the rabbit

To see if the known properties of thiopental of reducing Ca2+ and K+ fluxes across the myocardial sarcolemma account for its arrhythmogenic action, we have evaluated the effect of the anesthetic on spontaneous contractile activity induced in isolated rabbit papillary muscles. Thiopental (20 mg/l) prolonged the duration of sustained automaticity induced by stimulation at 1-2 Hz in the presence of 1 mumol/l isoproterenol. Thiopental (10, 20 mg/l) shortened the delay before the onset of Ba(2+)-induced automaticity, which involves a decrease in a K+ current. The minimum concentration of Ba2+ required to induce automaticity was lowered by thiopental. Whether spontaneous activities were induced by high frequency stimulation in the presence of isoproterenol or by Ba2+, thiopental lowered the frequency of spontaneous beats. Thus, thiopental appears to have both arrhythmogenic and antiarrhythmic actions, and the former may be unmasked when catecholamines counteract the latter by increasing Ca2+ influx. Like thiopental, halothane (1.0%) decreased the frequency and force of Ba(2+)-induced automatic beats but, unlike thiopental, prolonged the delay before the onset of Ba(2+)-induced automaticity, indicating that halothane acts as a purely antiarrhythmic agent in this type of automaticity.

Effects of the anesthetics heptanol, halothane and isoflurane on gap junction conductance in crayfish septate axons: a calcium- and hydrogen-independent phenomenon potentiated by caffeine and theophylline, and inhibited by 4-aminopyridine

This study has monitored junctional and nonjunctional resistance, [Ca2+]i and [H+]i, and the effects of various drugs in crayfish septate axons exposed to neutral anesthetics. The uncoupling efficiency of heptanol and halothane is significantly potentiated by caffeine and theophylline. The modest uncoupling effects of isoflurane, described here for the first time, are also enhanced by caffeine. Heptanol causes a decrease in [Ca2+]i and [H+]i both in the presence and absence of either caffeine or theophylline. A similar but transient effect on [Ca2+]i is observed with halothane. 4-Aminopyridine strongly inhibits the uncoupling effects of heptanol. The observed decrease in [Ca2+]i with heptanol and halothane and negative results obtained with different [Ca2+]o, (Ca2+)-channel blockers (nisoldipine and Cd2+) and ryanodine speak against a Ca2+ participation. Negative results obtained with 3-isobutyl-1-methylxanthine, forskolin, CPT-cAMP, 8Br-cGMP, adenosine, phorbol ester and H7, superfused in the presence and absence of caffeine and/or heptanol, indicate that neither the heptanol effects nor their potentiation by caffeine are mediated by cyclic nucleotides, adenosine receptors and kinase C. The data suggest a direct effect of anesthetics, possibly involving both polar and hydrophobic interactions with channel proteins. Xanthines and 4-aminopyridine may participate by influencing polar interactions. The potentiating effect of xanthines on cell-to-cell uncoupling by anesthetics may provide some clues on the nature of cardiac arrhythmias in patients treated with theophylline during halothane anesthesia.

Preventive effects of phenoxybenzamine on nitrous oxide-induced reproductive toxicity in Sprague-Dawley rats

In previous studies, we have shown that the reproductive toxicity of N2O in rats is prevented by the co-administration of either halothane or isoflurane, whereas treatment with folinic acid, which should reverse the effects of N2O on DNA production, does not prevent toxicity. These results cast doubt on the commonly held theory that inactivation of methionine synthase is the sole cause of N2O-induced reproductive toxicity, and suggest the need for other hypotheses. One such possibility is that N2O causes adverse reproductive toxicity secondary to its sympathomimetic effects. As a first step to test this theory, we studied the effects of phenoxybenzamine (PX), an alpha-1 adrenergic antagonist, on N2O-induced reproductive toxicity using a well-established in vivo rat model. On day 8 of gestation (plug day = day 0), 130 timed-pregnant Sprague-Dawley rats were injected s.c. with either 0.5 ml of either 0.9% saline (control and N2O alone groups) or PX (0.5, 5, or 50 micrograms/kg) in 0.9% saline, the latter the maximum tolerated PX dose. They were then exposed to either air (control) or 60% N2O for 24 hours (all other groups). On day 20 of gestation, cesarean sections were performed and the fetuses were removed and examined for either visceral of skeletal abnormalities. Compared with control, treatment with N2O alone resulted in increased incidences of fetal resorptions, major and minor visceral abnormalities, and minor skeletal abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Contribution of the known subcellular effects of anesthetics to their negative inotropic effect in intact myocardium

The results of these studies suggest that halothane, in addition to its effect of reducing the trans-sarcolemmal Ca2+ influx, has a direct effect on the function of the sarcoplasmic reticulum by making the organelle leaky to Ca2+ and reducing the amount of Ca2+ stored. Isoflurane, on the other hand, does not appear to make the sarcoplasmic reticulum leaky to Ca2+. In fact, our observations suggest that isoflurane makes the sarcoplasmic reticulum less leaky to Ca2+. Halothane may enhance the reduction in the myofibrillar response to activator Ca2+ when the muscle fiber length is shortened. Thiopental appears to reduce the trans-sarcolemmal Ca2+ influx without reducing the amount of Ca2+ stored in the sarcoplasmic reticulum.

Why does halothane relax cardiac muscle but contract malignant hyperthermic skeletal muscle?

We have studied the question of the possible role of sarcoplasmic reticulum (SR) in the interaction of volatile anesthetics (such as halothane, enflurane and isoflurane) with muscle. We used two cardiac muscle models, i.e., isolated rat myocytes and Langendorff perfused rat hearts. We compared the results with those for skeletal muscle SR from rabbits, rats and pigs susceptible to malignant hyperthermia (MH). In both skeletal and cardiac muscle SR, volatile anesthetics enhanced the calcium release from the SR. In cardiac muscle, these agents are known to decrease contractility (negative inotropism). We found that caffeine, a well-known agent which releases calcium from the SR, also had a negative inotropic effect in cardiac muscle, raising the possibility of an unexpected link between the potentiation of calcium release and mechanism underlying the observed negative inotropism. Current understanding of anesthetic mechanisms does not include this possibility. We further found that both volatile anesthetics and caffeine decrease the content of calcium in the SR, suggesting that the increase of calcium permeability results in the decrease of calcium ions in the SR which are available for excitation-contraction (E-C) coupling. In MH-susceptible skeletal muscle, a similar increase in calcium permeability does not cause a decrease of contractility, but rather may contribute to a fatal syndrome of temperature increase provoked by abnormal contracture. This difference may be because in skeletal myoplasm calcium ions recycle internally, while in the cardiac muscle cell they are in dynamic equilibrium with extracellular calcium ions.

Calcium-channel blockers and anaesthesia

Verapamil was the first calcium-channel blocker (CCB). It has been used since 1962 in Europe then in Japan for its antiarrhythmic and coronary vasodilator effects. The CCB have become prominent cardiovascular drugs during the last 15 years. Many experimental and clinical studies have defined their mechanism of action, the effects of new drugs in this therapeutic class, and their indications and interactions with other drugs. Due to the large number of patients treated with CCB it is important for the anaesthetist to know the general and specific problems involved during the perioperative period, the interactions with anaesthetics and the practical use of these drugs.

Temperature-dependent effects of halothane and isoflurane on the isolated left atrium

The aim of the present study was to examine whether changes in temperature alter the effects of halothane and isoflurane on isolated left atria. Concentration-response curves for inotropic effects at different temperatures (30 degrees C, 37 degrees C, 40 degrees C) on electrically stimulated left atria of the rat were obtained. The change of temperature modified the maximal negative inotropic response to halothane. The maximal decrease induced by halothane was 12 +/- 2.3 per cent at 37 degrees C and 18 +/- 2.5 per cent at 30 degrees C. When the temperature increased up to 40 degrees C the maximal decrease of atrial inotropism was 46 +/- 2.1 per cent--significantly higher than obtained at 37 degrees C. However, the maximal effect obtained by isoflurane was not significantly affected by temperature (30 degrees C = 7 +/- 1.6 per cent; 37 degrees C = 8 +/- 1.8 per cent; 40 degrees C = 2 +/- 0.8 per cent). Furthermore the potency of halothane (expressed as the concentration which produced 50 per cent inhibition - IC 50 per cent), decreased significantly at 30 degrees C (IC 50 = 1.34 +/- 0.18) and increased at 40 degrees C (IC 50 = 0.44 +/- 0.17) when compared with its potency at 37 degrees C (IC 50 = 0.96 +/- 0.08). On the other hand changes in temperature did not significantly modify the IC 50 for isoflurane obtained at 37 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mechanisms of action of halogenated anesthetics on isolated cardiac muscle]

The mechanisms responsible for the direct negative inotropic effects of the three currently used volatile anesthetics (halothane, enflurane and isoflurane) are reviewed. These agents interfere at each step of excitation-contraction coupling, i.e. sarcolemmal membrane, sarcoplasmic reticulum and contractile proteins. At the myofilament level, they decrease both calcium sensitivity and maximal developed force of cardiac skinned fibers of various species, a preparation in which all functional membranes are destroyed and thus allowing to study the direct effects of volatile anesthetics on myocardial contractile proteins. The effects of the three volatile anesthetics are similar at equipotent concentrations. The site of action seems to involve the regulatory proteins of the thin myofilament, especially troponin-tropomyosin complex. At the sarcolemmal level, all three anesthetics decrease Ca++ entry through the voltage-dependent calcium channels, an effect that seems slightly more important for both halothane and enflurane than for isoflurane. However, these two sites of action (contractile proteins and sarcolemmal membrane) are not sufficient to explain their overall negative inotropic effect. The third site of action involves the sarcoplasmic reticulum. Halothane and enflurane produce an initial liberation of Ca++ from internal stores, while isoflurane does not. All three agents decrease the net uptake of Ca++ and increase the permeability of sarcoplasmic reticulum to Ca++, similar to the effect of caffeine. However, the resulting effect, i.e. a reduction of sarcoplasmic reticulum Ca++ content occurs at clinical concentrations of halothane or enflurane, while much higher concentrations of isoflurane are required to produce a similar reduction. This differential effect on the sarcoplasmic reticulum function (which is quantitative but not qualitative) seems to be mainly responsible for the lesser negative inotropic effect of isoflurane as observed in intact cardiac muscles of various species including humans. The knowledge of the mechanisms of action of volatile anesthetics is important for understanding the potential consequences associated with their use in patients receiving cardiac drugs, especially calcium blockers and phosphodiesterase inhibitors.

Volatile anesthetics block intercellular communication between neonatal rat myocardial cells

The effects of halothane and ethrane on gap junction-mediated intercellular communication and on membrane excitability were examined in cultured neonatal rat cardiac myocytes using whole-cell voltage-clamp and current-clamp techniques. Excitability was maintained at doses of both anesthetics that reversibly abolished current flow through junctional membranes. The degree of reduction of junctional conductance was a steep function of the dose of anesthetic; complete block occurred at lower aqueous concentrations of halothane than ethrane. The time course for loss of communication was rapid; 90% reduction of initial junctional conductance occurred in less than 15 seconds after exposure to 2 mM halothane or 4 mM ethrane. Recovery of junctional conductance and junctional permeability to intracellularly injected Lucifer yellow was rapid and complete on washout of the anesthetics. As junctional conductance was reduced by halothane or ethrane exposure, unitary conductance of the gap junctional channels remained constant at about 50 pS. Uncoupling by these anesthetics is thus attributable to a decrease in the number of conducting channels rather than to reduction of the channel's unitary conductance. The data are discussed with regard to the possible role of this intercellular communication pathway in the arrhythmias and alterations of conduction velocity and contractility produced by volatile anesthetics.

Effects of halothane on arrhythmias induced by myocardial ischaemia

The effect of halothane on arrhythmias induced by ischaemia was investigated in rats, isolated perfused rat hearts, and pigs. Responses to the occlusion of the left anterior descending coronary artery were determined in groups (n = 9) of chronically prepared rats treated with no halothane, 0.5, or 1.0 per cent halothane immediately after occlusion; in isolated rat hearts (n = 10) treated with no halothane, 0.5, 1.0, 2.0, or 4.0 per cent halothane for 15 min before and after occlusion; and 20-25 kg pigs (n = 11) anaesthetised with halothane or pentobarbital. The ECG, arrhythmias, blood pressure (BP), heart rate (HR) and extent of infarction were determined in each model. In pigs, left ventricular pressure, dp/dtmax and cardiac output were also measured. In chronically prepared rats, halothane anaesthesia started after occlusion was antiarrhythmic and decreased the incidence of ventricular fibrillation and resulting mortality. In isolated rat hearts, 0.5 or 1.0 per cent halothane had little effect on occlusion-induced arrhythmias. The highest concentration of halothane increased the incidence of ventricular fibrillation both before and after occlusion. Halothane decreased developed ventricular pressure in a dose-dependent manner. In acutely prepared pigs, halothane pre-treatment had no appreciable effect upon occlusion-induced arrhythmias when compared with pentobarbital anaesthesia. Thus, halothane is antiarrhythmic when treatment is initiated after occlusion in the rat but this action is not seen in isolated hearts or intact pigs. The antiarrhythmic action of halothane is, therefore, species and model dependent.

Effects of volatile anesthetics on cardiac calcium channels

In order to investigate how volatile anesthetics affect cardiac calcium channels, the effects of halothane, enflurane, and isoflurane on the specific binding of [3H]-nitrendipine to bovine heart sarcolemmal membranes were studied. All three anesthetics added in liquid form inhibited [3H]-nitrendipine binding in a dose-dependent manner, and more interestingly, the order of inhibition by these volatile anesthetics roughly followed that of their anesthetic potencies. The partial pressures, calculated using the gas/water partition coefficients of halothane, enflurane, and isoflurane which inhibited [3H]-nitrendipine binding by 30% at 37 degrees C were about 1.48 x 10(-2) atm. (1.48%), 4.89 x 10(-2) atm. (4.89%) and 2.76 x 10(-2) atm. (2.76%), respectively. One mmol/l halothane altered not only the maximal binding (Bmax) from 189 f mol/mg protein to 136 f mol/mg protein, but also the dissociation constant (Kd) from 0.074 nmol/l to 0.18 nmol/l. Halothane was also added to the reaction mixture in the gaseous form with air. The partial pressure of halothane needed to bring about 30% inhibition was 0.82 x 10(-2) (0.82%), a value almost similar to that for halothane added in the liquid form. These results indicate that all three volatile anesthetics have direct effects on cardiac calcium channels, and that the magnitude of the effects depends on their anesthetic potencies.

Effects of halothane on membrane ionic currents in guinea pig atrial and ventricular myocytes

We studied the effects of halothane on membrane potentials and ionic currents in single guinea pig atrial and ventricular cells prepared by an enzymatic dispersion procedure. In both atrial and ventricular cells, action potential overshoot and its plateau phase were significantly decreased by halothane (2%) without change in resting potential. However, the duration of the ventricular action potential measured at 90% repolarization was markedly shortened by halothane (2%) (to 60% of control), whereas that of the atrial action potential did not change significantly. Corresponding voltage clamp experiments demonstrated that in atrial cells halothane (2%) significantly depresses the time- and voltage-dependent outward K+ current (IK) (to 46% of control); and that in ventricular cells IK is then nearly absent. In both atrial and ventricular cells halothane had no effect on the inwardly rectifying K+ current (IK1). On the other hand, halothane (2%) decreased the slow inward Ca2+ current (ICa) in both atrial and ventricular cells (to 36% and 29% of control, respectively). The results suggest that the shortened action potential in ventricular cells by halothane may well be responsible for the decrease of the plateau phase resulting from the depression of ICa; and that in atrial cells the depression of IK and ICa by halothane had no significant effect on the duration of action potential.

Interaction of verapamil and halogenated inhalation anesthetics on hypoxic pulmonary vasoconstriction

Calcium channel blockers and halogenated inhalation anesthetics reduce hypoxic pulmonary vasoconstriction (HPV) when administered separately to isolated rat lungs. This study was undertaken to investigate the effect of combining the calcium channel blocker verapamil with halothane or isoflurane. HPV was elicited in three groups of experiments. First, we studied the effect of halothane 1.3 MAC and varying concentrations of verapamil. Halothane reduced HPV as a mean by 34.7%, and a dose-dependent reduction was seen with verapamil. The depressant effect of the combination of halothane and verapamil was significantly greater than when the drugs were administered alone. We further investigated in separate groups the effects of varying concentrations of halothane and isoflurane, administered both separately and in combination with a constant dose of verapamil (1.02 nmol). Both anesthetics depressed HPV in a dose-dependent fashion. Verapamil reduced HPV as a mean by 34.2% and 39.3% in the halothane and isoflurane groups, respectively. The inhibition caused by combining verapamil with an anesthetic was significantly greater than when administered separately. We conclude that verapamil in combination with halothane or isoflurane has an additive dampening effect on HPV.

Effects of general anesthetics on current flow across membranes in guinea pig myocytes

Myocytes were isolated from adult guinea pig ventricles. Whole cell, tight-seal recording was employed to investigate the electrical properties of the junctional (nexal membrane) and nonjunctional membrane (sarcolemma) under the influence of n-alkanols (heptanol, octanol) and halothane. Studies of cell pairs with a double voltage-clamp approach showed that these agents give rise to a reversible electrical uncoupling. Examination of single myocytes with a single voltage-clamp method showed that these substances modify several sarcolemmal current systems. The slope conductance was reduced over the entire voltage range examined (-90 to +50 mV). The Ca2+ inward current (Isi) showed a decreased amplitude and an accelerated inactivation. The repriming of Isi remained unchanged. The steady-state inactivation of Isi was shifted by 2-3 mV toward more negative potentials. Optical measurements demonstrated an increase in sarcomere spacing at rest and a decrease during peak systolic shortening. The results suggest that n-alkanols and halothane exert their effects on membrane currents via incorporation into the lipid bilayer.

Halothane anesthesia reduces inducibility of ventricular tachyarrhythmias in chronic canine myocardial infarction

This study examined the effects of 2% halothane general anesthesia on ventricular electrophysiological properties and inducibility of sustained ventricular tachycardia (VT) and ventricular fibrillation (VF). Dogs with chronic anterior infarction and control dogs (no infarction) were studied before and after anesthesia using chronically implanted ventricular epicardial electrodes. PQ interval was increased by 15% with halothane, but QRS duration, QT interval, QTc, and sinus rhythm cycle length were unaffected by anesthesia. Diastolic threshold was unchanged by halothane. Halothane caused significant increases of 10-30% in ventricular effective refractory period (ERP) both in control and in infarct animals. VT and VF were not inducible in any of the nine control animals either before or after anesthesia. In infarct animals 34 of 75 (45%) had inducible VT or VF prior to halothane, but the incidence of inducible arrhythmias was significantly lower at 29% (22 of 75 animals) after halothane (p less than 0.01). In 75% of animals in which halothane suppressed inducibility of tachyarrhythmias, halothane-induced increases in ERP prevented achievement of the short extrastimulus coupling intervals at which the arrhythmias were induced before anesthesia.

IN CONCLUSION

halothane anesthesia reduces the incidence of inducible sustained ventricular tachyarrhythmias in chronic canine myocardial infarction.

Effects of halothane and calcium entry blockers on atrioventricular conduction-a comparative study of verapamil, diltiazem, and nifedipine

The effects of halothane on AV nodal function were evaluated in dogs with verapamil, diltiazem, or nifedipine during atrial pacing using the technique of His-bundle electrocardiography. Fifty-one mongrel dogs were divided into six groups. Anesthesia was induced with ketamine 100 mg im. and thiamylal 25 mg/kg iv. The animals were intubated and mechanically ventilated at normocapneic levels. Anesthesia was maintained with 50% nitrous-oxide in oxygen with pancuronium 2 mg im. Dogs in groups I, III, and V were anesthetized with 0.8% halothane and 50% nitrous-oxide in oxygen. We observed interactions between halothane and intravenous administration of either verapamil 0.1 mg/kg, diltiazem 0.15 mg/kg, or nifedipine 0.01 mg/kg respectively. Dogs in groups II, IV, and VI were administered either verapamil, diltiazem, or nifedipine iv without halothane. There were prolongations of sinus cycle length (SCL) (414 +/- 10 to 542 +/- 19 msec.), atrium-His (AH) interval (73 +/- 3 to 97 +/- 5 msec.), and functional refractory period (FRP) of the AV-node (227 +/- 5 to 260 +/- 5 msec.) in halothane anesthesia in groups I, III, and V. There were more prolongations of these variables after iv administration of verapamil (SCL; 617 +/- 35, AH; 118 +/- 7, FRP of the AV node; 311 +/- 4) and diltiazem (SCL; 554 +/- 19, AH; 118 +/- 12, FRP of the AV node; 283 +/- 12) but no prolongations after nifedipine (SCL; 533 +/- 19, AH; 99 +/- 8, FRP of the AV node; 272 +/- 9). Comparing effects of calcium entry blockers with and without halothane in groups I and II, III and IV, or V and VI, there were additive depressing effects of halothane with either verapamil or diltiazem on AV nodal function. And there is a difference between the effects of nifedipine on SCL with and without halothane.

Myocardial recovery from the cardiac depressant effects of enflurane and halothane

Recovery from the cardiac depressant effects of enflurane and halothane was examined in the dog heart-lung preparation (HLP) and in right ventricular muscle isolated from guinea pig hearts. In the HLP. recovery was studied under two conditions: (1) After a two-hour exposure to anesthetic concentrations increasing from 0.36 to 1.2 MAC, and (2) after a one-hour exposure to a single concentration that raised the left atrial pressure (LAP) to 9 to 10 mmHg. Under either condition, +dP/dtmax. was significantly less depressed with enflurane and returned to preanesthetic control levels, while recovery with halothane remained significantly below control. Following the longer exposure. recovery of the LAP and left ventricular function curves (LVFC) was significantly less with halothane; however, this difference was not observed after the shorter exposure period. In electrically paced, isometrically contracting right ventricular strips exposed for one hour to 2.25 vol% enflurane (a concentration that reduced contractility by 45%), force development returned within 60 minutes to values above preanesthetic control values. After an identical depression for one hour with halothane (0.80 vol%), force development recovered to values less than those observed following enflurane. These data indicate that the recovery from anesthetic-induced negative inotropic effects in isolated cardiac preparations is better with enflurane than halothane.