Sevoflurane provides better haemodynamic stability than propofol during right ventricular ischaemia-reperfusion

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.