Effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients undergone esophagectomy

Abstract

Object: Sevoflurane and propofol are both widely used in clinical anesthesia. The aim of this study is to compare the effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients receiving esophagectomy.

Methods: Forty adult patients undergoing an elective open-chest thoracotomy for esophagectomy were randomized to receive either propofol (n=20) or sevoflurane (n=20) as the main anesthetic agent. The study was performed in Changzheng Hospital. Hemodynamic data were recorded at specific intervals: before the surgery (T0), BIS values reaching 40 after anesthesia induction (T1), two-lung ventilation (T2), ten minutes after one-lung ventilation (T3), the end of the operation (T4) using PiCCO2 and Swan-Ganz catheter.

Results: CI, RVEF, RVSWI and RVEDVI were significantly smaller in propofol group than those in sevoflurane group throughout the surgery (P<0.05). However, SVRI was significantly greater in propofol group than that in sevoflurane group (P<0.05). Compared with the patients in propofol group, the patients who received sevoflurane had a greater reduction in OI and increase in Os/Ot (P<0.05). And, PVRI was significantly smaller in sevoflurane group than in propofol group (P<0.05).

Conclusion: Anesthesia with sevoflurane preserved better right ventricular function than propofol in patients receiving esophagectomy. However, propofol improved oxygenation and shunt fraction during one-lung ventilation compared with sevoflurane anesthesia. To have the best effect, anesthesiologists can choose the two anesthetics flexibly according to the monitoring results.

Keywords: Sevoflurane; esophagectomy; propofol; pulmonary circulation; right ventricular function.

Figures

Figure 1

Changes in hemodynamic data at after anesthesia induction (T1), two lung ventilation (T2), one lung ventilation (T3) and the end of the operation (T4) in propofol group and sevoflurane group. A was mean arterial pressure (MAP), B was stroke volume index (SVI), C was Cardiac index (CI), D was stroke volume index (SVI), E was mean pulmonary artery pressure (PMAP), F was central venous pressure (CVP), G was pulmonary artery wedge pressure (PAWP). The values for MAP (P=0.140), SVI (P=0.369), PMAP (P=0.790), CVP (P=0.899), and PAWP (P=0.203) did not significant differ between two groups. CI was significantly smaller in propofol group than in sevoflurane group throughout the surgery (P=0.007). SVRI was significantly greater in propofol group than in sevoflurane group (P=0.022). *P

Figure 2

Changes in right ventricular function data at after anesthesia induction (T1), two lung ventilation (T2), one lung ventilation (T3) and the end of the operation (T4) in propofol group and sevoflurane group. A was right ventricular ejection fraction (RVEF), B was RV stroke work index (RVSWI), C was RV end-diastolic volume index (RVEDVI). RVEF (P=0.008), RVEDVI (P=0.019), RVSWI (P=0.003) were significantly smaller in propofol group than in sevoflurane group throughout the surgery. *P

Figure 3

Changes in pulmonary circulation data at two lung ventilation (T2), one lung ventilation (T3) and the end of the operation (T4) in propofol group and sevoflurane group. A was pulmonary shunt fraction (Qs/Qt), B was oxygenation index (OI), C was pulmonary vascular resistance index (PVRI), D was transmembrane pressure. OI decreased more greatly in sevoflurane group than in propofol group (P=0.000). Qs/Qt increased more greatly in sevoflurane group than in propofol group (P=0.000). PVRI was significantly smaller in sevoflurane group than in propofol group (P=0.016). *P