From the Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.
Department of Surgery, University of Melbourne, Melbourne, Australia.
Anesth Analg. 2018 Aug;127(2):387-397. doi: 10.1213/ANE.0000000000003450.
Desflurane and propofol are cardioprotective, but relative efficacy is unclear. The aim was to compare myocardial protection of single, simultaneous, and serial administration of desflurane and propofol.
Sixty New Zealand White rabbits and 65 isolated Sprague Dawley rat hearts randomly received desflurane, propofol, simultaneous desflurane and propofol, or sequential desflurane then propofol. Rabbits were subdivided to receive either ischemia-reperfusion with temporary occlusion of the left anterior descending artery or a time-matched, nonischemic perfusion protocol, whereas rat hearts were perfused in a Langendorff model with global ischemia-reperfusion. End points were hemodynamic, functional recovery, and mitochondrial uptake of H-2-deoxy-D-glucose as an indicator of mitochondrial permeability transition.
In rabbits, there were minimal increases in preload-recruitable stroke-work with propofol (P < .001), desflurane (P < .001), and desflurane-and-propofol (P < .001) groups, but no evidence of increases with pentobarbitone (P = .576) and desflurane-then-propofol (P = .374). In terms of end-diastolic pressure-volume relationship, there was no evidence of increase compared to nonischemic controls with desflurane-then-propofol (P = .364), a small but significant increase with desflurane (P < .001), and larger increases with pentobarbitone (P < .001), propofol (P < .001), and desflurane-and-propofol (P < .001).In rat hearts, there was no statistically significant difference in mitochondrial H-activity between propofol and desflurane-and-propofol (165 ± 51 × 10 vs 154 ± 51 × 10 g·mL·min/μmol; P = .998). Desflurane had lower uptake than propofol (65 ± 21 × 10 vs 165 ± 51 × 10 g·mL·min/μmol; P = .039), but there was no statistically significant difference between desflurane and desflurane-then-propofol (65 ± 21 × 10 vs 59 ± 11 × 10 g·mL·min/μmol; P = .999).
Propofol and desflurane are cardioprotective, but desflurane is more effective than propofol. The added benefit of desflurane is lost when used simultaneously with propofol.
地氟醚和丙泊酚具有心脏保护作用，但它们的相对疗效尚不清楚。本研究旨在比较地氟醚和丙泊酚单次、同时和序贯给药的心肌保护作用。
60 只新西兰白兔和 65 只分离的 Sprague Dawley 大鼠心脏随机接受地氟醚、丙泊酚、地氟醚和丙泊酚同时给药或地氟醚序贯给予丙泊酚。兔子被分为接受左前降支短暂闭塞的缺血再灌注或时间匹配的非缺血灌注方案，而大鼠心脏在 Langendorff 模型中进行全心缺血再灌注。终点为血流动力学、功能恢复和作为线粒体通透性转换指标的 H-2-脱氧-D-葡萄糖的线粒体摄取。
在兔子中，与戊巴比妥（P =.576）和地氟醚-然后-丙泊酚（P =.374）相比，丙泊酚（P <.001）、地氟醚（P <.001）和地氟醚-然后-丙泊酚（P <.001）组的预负荷可募集功仅有微小增加，而地氟醚-然后-丙泊酚（P =.364）与非缺血对照组相比，无证据表明终末舒张压力-容积关系增加，与戊巴比妥（P <.001）、丙泊酚（P <.001）和地氟醚-然后-丙泊酚（P <.001）相比，地氟醚组有较小但显著的增加。在大鼠心脏中，丙泊酚和地氟醚-然后-丙泊酚之间的线粒体 H-活性没有统计学差异（165 ± 51×10 对 154 ± 51×10 g·mL·min/μmol；P =.998）。地氟醚的摄取量低于丙泊酚（65 ± 21×10 对 165 ± 51×10 g·mL·min/μmol；P =.039），但地氟醚与地氟醚-然后-丙泊酚之间无统计学差异（65 ± 21×10 对 59 ± 11×10 g·mL·min/μmol；P =.999）。
丙泊酚和地氟醚具有心脏保护作用，但地氟醚比丙泊酚更有效。当与丙泊酚同时使用时，地氟醚的附加益处丧失。
