麻醉与器官保护.pptVIP

The ischaemia and reperfusion protocol was commenced after a period of stabilisation following the surgery to insert the pressure-volume loop catheters These pictures are examples of the heart after it is exercised and stained. Blue tissue is tissue that was not potentially at risk of ischaemia. Red tissue is part of the area at risk, but is viable tissue (not infarcted). Pale white tissue is not viable and represents infarct. We made sure that the area at risk was tatleast 20% of the left ventricle (indicating a large ischaemic insult), and that it was not different between groups. What this graph shows is the infarct size relative to the area at risk. On the left graph, the results for median and range are shown, and the right graph is the mean and standard error. Both sevoflurane and desflurane produced much smaller infarct size relative to area at risk, indicating cardiac protection compared to propofol. This finding was consistent with previous literature, indicating a cardiac protective effect with the volatile anaesthetics. Our assumption, was that this would translate to differences in haemodynamic performance, and in contractility. The graphs above show each drug compared to its own time control. The change from baseline data are presented. Surprisingly, we did not find any significant difference for contractility for any of the drugs between the ischaemia and time control groups. The same result was found for mean arterial pressure. It was only when we examined the diastolic stiffness (which is perhaps the most sensitive measurement for ischaemic change) that we were able to show a difference between drugs or their time control. Propofol and sevoflurane both demonstrated increased diastolic stiffness with ischaemia, with sevoflurane returning to control values more rapidly than propofol. There was no difference in diastolic stiffness with desflurane. I think these results explain why my colleague could not find a difference between pr