Xenon and isoflurane improved biventricular function during right ventricular ischemia and reperfusion

• Published in: Acta anaesthesiologica Scandinavica Vol. 54; no. 4; pp. 470 - 478
• Main Authors: HEIN, M., ROEHL, A. B., BAUMERT, J. H., BLEILEVENS, C., FISCHER, S., STEENDIJK, P., ROSSAINT, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2010; Blackwell
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - therapeutic use; Animals; Biological and medical sciences; Cardiac Output - drug effects; Cardiac Output - physiology; Data Interpretation, Statistical; Isoflurane - pharmacology; Medical sciences; Myocardial Contraction - drug effects; Myocardial Contraction - physiology; Myocardial Reperfusion Injury - physiopathology; Myocardial Reperfusion Injury - prevention & control; Natriuretic Peptide, Brain - blood; Natriuretic Peptide, Brain - genetics; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger - biosynthesis; RNA, Messenger - genetics; Swine; Ventricular Dysfunction, Right - drug therapy; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Left - physiology; Xenon - therapeutic use; Volatile compound; General anesthetic; Ischemia reperfusion; Xenon; Anesthesia; Isoflurane; Halogen Organic compounds
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2009.02116.x

Background: Although anesthetics have some cardioprotective properties, these benefits are often counterbalanced by their negative inotropic effects. Xenon, on the other hand, does not influence myocardial contractility. Thus, xenon may be a superior treatment for the maintenance of global hemodynamics, especially during right ventricular ischemia, which is generally characterized by a high acute complication rate. Methods: The effects of 70 vol% xenon and 0.9 vol% isoflurane on biventricular function were assessed in a porcine model (n=36) using the conductance catheter technique, and the expression of the type B natriuretic peptide (BNP) gene was measured. The animals underwent 90 min of right ventricular ischemia followed by 120 min of reperfusion. A barbiturate‐anesthetized group was included as a control. Results: Cardiac output was compromised in unprotected animals during ischemia by 33±18% and during reperfusion by 53±17%. This was mainly due to impaired contractility in the left ventricle (LV) and increased stiffness. Isoflurane attenuated the increase in stiffness and resulted in a higher preload. In contrast, xenon increased the right ventricular afterload, which was compensated by an increase in contractility. Its effects on diastolic function were less pronounced. Upregulation of BNP mRNA expression was impeded in the remote area of the LV by both isoflurane and xenon. Conclusions: Xenon and isoflurane demonstrated equipotent effects in preventing the hemodynamic compromise that is induced by right ventricular ischemia and reperfusion, although they acted through somewhat differential inotropic and vasodilatory effects.