Inhaled Anesthetics Alter the Determinants of Coronary Collateral Blood Flow in the Dog

Abstract

Background Whether coronary steal is induced by inhaled anesthetic agents remains controversial in part because multiple factors determine collateral blood flow. Methods We used an established model to determine how halothane, isoflurane, and desflurane affect the hemodynamic determinants of coronary collateral blood flow. Twelve dogs were studied 4-5 weeks after ameroid constrictor implantation. Retrograde flow draining from the occluded artery was measured as an index of collateral flow after antegrade embolization. Pressure in the supplying artery at the origin of the collaterals was estimated with a stop-flow technique. These techniques allow calculation of collateral segment resistance and the resistances of the supply artery upstream and downstream from the origin of the collaterals. Results None of the inhaled anesthetics affected collateral segment resistance. Downstream (arteriolar) resistance of the supplying artery was decreased by desflurane (-45%), isoflurane (-35%), and halothane (-15%), lowering pressure at the origin of the collaterals, an effect that was partially offset by a decrease in upstream resistance. Retrograde flow was unaffected by isoflurane and halothane but decreased by about 20% during desflurane administration. Conclusions Inhaled anesthetics have many effects on segmental resistance and pressure in the coronary circulation. These findings help explain conflicting results from previous studies and provide a useful model for investigating the effects of inhaled agents on small coronary arteries.