Isoflurane and sevoflurane anesthesia in pigs with a preexistent gas exchange defect

Background Decreased arterial partial pressure of oxygen (Pao2) during volatile anesthesia is well-known. Halothane has been examined with the multiple inert gas elimination technique and has been shown to alter the distribution of pulmonary blood flow and thus Pao2. The effects of isoflurane and sevoflurane on pulmonary gas exchange remain unknown. The authors hypothesized that sevoflurane with a relatively high minimum alveolar concentration (MAC) would result in significantly more gas exchange disturbances in comparison with isoflurane or control. Methods This study was performed in a porcine model with an air pneumoperitoneum that generates a reproducible gas exchange defect. After a baseline measurement of pulmonary gas exchange (multiple inert gas elimination technique) during propofol anesthesia, 21 pigs were randomly assigned to three groups of seven animals each. One group received isoflurane anesthesia, one group received sevoflurane anesthesia, and one group was continued on propofol anesthesia (control). After 30 min of volatile anesthesia at 1 MAC or propofol anesthesia, a second measurement (multiple inert gas elimination technique) was performed. Results At the second measurement, inert gas shunt was 15 ± 3% (mean ± SD) during sevoflurane anesthesia versus 9 ± 1% during propofol anesthesia (P = 0.02). Blood flow to normal ventilation/perfusion (VA/𝑄) lung areas was 83 ± 5% during sevoflurane anesthesia versus 89 ± 1% during propofol anesthesia (P = 0.04). This resulted in a Pao2 of 88 ± 11 mmHg during sevoflurane anesthesia versus 102 ± 15 mmHg during propofol anesthesia (P = 0.04). Inert gas and blood gas variables during isoflurane anesthesia did not differ significantly from those obtained during propofol anesthesia. Conclusions In pigs with an already existent gas exchange defect, sevoflurane anesthesia but not isoflurane anesthesia causes significantly more gas exchange disturbances than propofol anesthesia does.