Microvascular changes during anesthesia: sevoflurane compared with propofol.
BACKGROUND
We have developed a non-invasive computer-assisted venous congestion plethysmograph to measure the microvascular parameters in the lower limbs. This enables the assessment of microvascular changes following the induction of standardized anesthesia with either sevoflurane or propofol.


METHODS
In a prospective randomized trial we measured the capillary filtration coefficient (CFC), isovolumetric venous pressure (Pvi), an index of the balance of Starling forces, and limb blood flow 24 h preoperatively, immediately after induction of anesthesia and on the 1st and 2nd postoperative day. Anesthesia was maintained with either 1.0% sevoflurane and 5 microg/kg/h remifentanil or propofol (3 mg/kg/h), and 5 microg/kg/h remifentanil in 20 female patients undergoing breast surgery.


RESULTS
Preoperatively we found no significant differences between the mean CFC values of the sevoflurane group (3.7+/-0.3 ml/min 100 ml tissue/mmHg x 10-3=CFCU) and the propofol group (3.5+/-0.3 CFCU). In the sevoflurane group CFC decreased significantly to 2.9+/-0.2 CFCU, whereas it was unchanged in the propofol group. Both groups revealed a significant reduction in Pvi during steady-state anesthesia. Limb blood flow remained unchanged. There was an overall significant positive correlation between the perioperative fluid substitution and the difference between the preoperative and intraoperative CFC values (r = 0.64, P<0.01).


CONCLUSIONS
The decreased CFC in response to sevoflurane may result in less extravasation of fluids into the interstitial space, thereby reducing intraoperative fluid requirements. These data suggest that sevoflurane may be the preferred anesthetic agent in subjects susceptible to large intraoperative fluid shifts.
Bruegger
D
D
Clinic for Anesthesiology, Ludwig Maximilians University Munich, Germany.
Bauer
A
A
Finsterer
U
U
Bernasconi
P
P
Kreimeier
U
U
Christ
F
F
D000328:Adult; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D001810:Blood Volume / Q000502:physiology; D001940:Breast / Q000601:surgery; D002199:Capillary Permeability / Q000187:drug effects; D003102:Colloids; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D008738:Methyl Ethers; D008833:Microcirculation / Q000187:drug effects*; D009997:Osmotic Pressure; D010991:Plethysmography; D015742:Propofol; D012039:Regional Blood Flow / Q000187:drug effects; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003102:Colloids; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol