BJA Advance Access originally published online on August 27, 2009
British Journal of Anaesthesia 2009 103(5):654-664; doi:10.1093/bja/aep238
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Functional comparison of anaesthetic agents during myocardial ischaemia–reperfusion using pressure–volume loops
1 Cardiovascular and Therapeutics Unit, Department of Pharmacology, University of Melbourne, Melbourne, Australia
2 Department of Cardiac Surgery and
3 Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
* Corresponding author. E-mail: andrewsdt{at}me.com
Background: Left ventricular (LV) pressure–volume (PV) loops were used to compare the functional effects that accompany the cardioprotection seen with desflurane, sevoflurane, and propofol in a rabbit preparation of coronary ischaemia–reperfusion (IR).
Methods: Male New Zealand White rabbits (n=48) were anaesthetized with propofol (70 mg kg–1 h–1), desflurane (8.9%), or sevoflurane (3.8%) and randomized to receive IR or non-ischaemic time-matched (TC) perfusion protocol. IR groups (desIR, propIR, and sevIR) underwent 30 min of left anterior descending coronary artery occlusion and then 120 min of reperfusion. TC groups (desTC, propTC, and sevTC) were anaesthetized for 150 min without ischaemia. Haemodynamic endpoints included mean arterial pressure, heart rate, cardiac index, systemic vascular resistance index, preload-recruitable stroke-work, time constant of relaxation (
), and end-diastolic PV relationship (EDPVR). Ventricles in the IR groups were excised and stained with 2,3,5-triphenyl-tetrazolium chloride in order to measure infarct size.
Results: Myocardial infarction size was greater in the propIR group [35.74 (SD 11.32)%] compared with the desIR [13.44 (3.09)%] and sevIR [17.96 (6.63)%] groups (P<0.001). EDPVR deteriorated in the sevIR and propIR groups compared with their TC groups, sevTC (P=0.03) and propTC (P=0.044), respectively. There was no difference in any haemodynamic endpoints for the desIR group compared with its TC control (desTC).
Conclusions: During ischaemia, all anaesthetics provide haemodynamic stability and preservation of LV contractility, whereas propofol and sevoflurane, but not desflurane, caused increased LV diastolic stiffness. Desflurane and sevoflurane provide superior cardioprotection compared with propofol.
Keywords: anaesthetics i.v., propofol; anaesthetics volatile; heart, ischaemia; research, anaesthesia
Declaration of interest. C.F.R. is a member of an advisory board on quality of recovery after anaesthesia, which is funded by an unrestricted educational grant from Baxter Healthcare.