Abstract
Isoflurane has been contended to be a “powerful” coronary vasodilator contributing to myocardial ischemia by causing a coronary steal mechanism [19, 20]. Although harmful effects on ischemic myocardium have been observed with intravenous anesthesia techniques as well [3, 6, 24], some recent studies in experimental animals [8, 9, 12] as well as clinical investigations [17–21] point towards a particular potential of inhalation anesthesia to aggravate myocardial ischemia, while others do not [3, 4, 16, 29, 41]. In this paper we describe the overall effects of isoflurane on the cardiovascular system and the simultaneous changes of coronary blood flow in comparison with the vascular and myocardial effects of the potent coronary vasodilator dipyridamole. As the most important effect of myocardial ischemia is its impact on myocardial function, we review the influence of isoflurane on the contractile function of both normal and chronically ischemic myocardium.
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