Effects of anesthetics on the coronary circulation

The coronary circulation holds a unique position among the different vascular beds because it perfuses the organ that generates the perfusion pressure for the entire circulation. Therefore the maintenance of an adequate perioperative coronary flow is one of the primary goals of good anesthetic management. This is especially important when coronary flow is already diminished such as is the case with arteriosclerotic disease. All anesthetics influence coronary flow to some extent. Some of them however also affect the normal physiologic responses of this system and may compromise coronary circulation and hence myocardial function. Therefore, knowledge of the coronary physiology and the effects of anesthetics on it is essential for every anesthetist dealing with patients with coronary artery disease. This article reviews the anatomy and physiology of the coronary circulatory system and resumes the present state of knowledge of the effects of the common used anesthetics on the coronary circulation