The cardiovascular changes associated with equipotent anaesthesia with either propofol or isoflurane

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Abstract
The differences in effects of anaesthetic agents on right ventricular function have not been studied. We have developed a cross-over study design to compare the effects of propofol and isoflurane on cardiac and specifically right ventricular function. Ten patients were anaesthetised with equivalent MAC of isoflurane to MIR of propofol. After measurements had been taken on the randomly assigned first agent the patients were crossed over to the other agent and measurements were repeated. Cardiac function was assessed using a pulmonary artery catheter with a fast response thermistor. There were no differences in heart rate or blood pressure between the two agents suggesting that equivalent anaesthetic doses had been given. There were significantly (P < 0.05) higher cardiac output (4.0 to 4.5 l.min-1), right ventricular ejection fraction (35.1 to 39.4%), stroke volume (35.4 to 39.6 ml) and right ventricular end-diastolic volume index (102 to 110 ml.m2-1) with propofol compared to isoflurane. We conclude that propofol results in improved right ventricular performance compared to isoflurane. We have also shown that anaesthetic agents can be compared using a cross-over study design, and have demonstrated that MAC of isoflurane and MIR of propofol can be directly compared. We suggest that propofol may be a more suitable agent than isoflurane for anaesthesia in patients who may already have impaired right ventricular function and in whom maintaining high cardiac output may be beneficial.