Sevoflurane provides better haemodynamic stability than propofol during right ventricular ischaemia–reperfusion. (3rd October 2019)

• Record Type: Journal Article
• Authors: Haraldsen, Pernille; Cunha-Goncalves, Doris; Metzsch, Carsten; Algotsson, Lars; Lindstedt, Sandra; Ingemansson, Richard
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 30:Number 1(2020)
• Page Start: 129
• Page End: 135
• Publication Date: 2019-10-03
• Subjects: Sevoflurane -- Propofol -- Right ventricular -- Ischaemia–reperfusion -- Cardioprotection; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivz235
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: To assess whether sevoflurane provides better haemodynamic stability than propofol in acute right ventricular (RV) ischaemia–reperfusion. METHODS: Open-chest pigs (mean ± standard deviation, 68.8 ± 4.2 kg) anaesthetized with sevoflurane ( n = 6) or propofol ( n = 6) underwent 60 min of RV free wall ischaemia and 150 min of reperfusion. Haemodynamic parameters and blood flow in the 3 major coronary arteries were continuously monitored. Biomarkers of cardiac ischaemia were analysed. RESULTS: Mean arterial pressure and stroke volume decreased, whereas pulmonary vascular resistance increased equally in both groups. Heart rate increased 7.5% with propofol ( P < 0.05) and 17% with sevoflurane ( P < 0.05). At reperfusion, left atrial pressure and systemic vascular resistance decreased with sevoflurane. While RV stroke work (mmHg·ml) and cardiac output (l·min −1 ) decreased in the propofol group (4.2 ± 1.2 to 2.9 ± 1.7 and 2.65 ± 0.44 to 2.28 ± 0.56, respectively, P < 0.05 both), they recovered to baseline levels in the sevoflurane group (4.1 ± 1.5 to 4.0 ± 1.5 and 2.77 ± 0.6 to 2.6 ± 0.5, respectively, P > 0.05). Circumflex and left anterior descending coronary artery blood flow decreased in both groups. Right coronary artery blood flow (ml·min −1 ) decreased with propofol (38 ± 9 to 28 ± 9, P < 0.05), but not with sevoflurane (28 ± 11 to 28 ± 17, P > 0.05). Biomarkers of cardiac ischaemia increased in both groups. CONCLUSIONS: Compared to propofol, sevoflurane-anaesthetized pigs showed higher RV stroke work, cardiac output and right coronary artery blood flow during reperfusion. These findings warrant a clinical trial of sevoflurane in RV ischaemia in humans.