Functional comparison of anaesthetic agents during myocardial ischaemia–reperfusion using pressure–volume loops D.T. Andrews, A.G. Royse, C.F. Royse

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Functional comparison of anaesthetic agents during myocardial ischaemia–reperfusion using pressure–volume loops D.T. Andrews, A.G. Royse, C.F. Royse British Journal of Anaesthesia Volume 103, Issue 5, Pages 654-664 (November 2009) DOI: 10.1093/bja/aep238 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 1 An original registration of a family of PV loops that occurs during acute preload reduction. The parameters in the first four panels are plotted against time. The first panel is instantaneous LV volume. The second panel is instantaneous LV pressure. The third panel is the first derivative of LV pressure (dp/dt). The fourth panel is the electrocardiograph. The last panel is the LV pressure plotted simultaneously against the corresponding LV volume (PV loop). The line intersecting the dots at the base of the family of PV loops is the EDPVR, and the steeper line to the left is the end-systolic PV relationship (measure of contractility, not used in this experiment). The individual area of each PV loop (stroke-work) when plotted against the corresponding end-diastolic pressure gives a straight-line relationship. The gradient of this line is the PRSW (not shown). British Journal of Anaesthesia 2009 103, 654-664DOI: (10.1093/bja/aep238) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 2 Cardio-circulatory, LV systolic and diastolic function endpoints, comparing the IR and the time-control groups for propofol. Data are presented as mean (sem). *P=0.044 for the group×time interaction for EDPVR, otherwise P=NS for all other group×time interactions (RM-anova with the Greenhouse–Geisser correction). HR, heart rate; MAP, mean arterial pressure; CI, cardiac index; SVRI, systemic vascular resistance index; PRSW, preload-recruitable stroke-work (contractility); EDPVR, end-diastolic PV relationship (diastolic stiffness). British Journal of Anaesthesia 2009 103, 654-664DOI: (10.1093/bja/aep238) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 3 Cardio-circulatory, LV systolic and diastolic function endpoints, comparing the IR and the time-control groups for sevoflurane. Data are presented as mean (sem). *P=0.03 for the group×time interaction for EDPVR, otherwise P=NS for all other group×time interactions (RM-anova with the Greenhouse–Geisser correction). HR, heart rate; MAP, mean arterial pressure; CI, cardiac index; SVRI, systemic vascular resistance index; PRSW, preload-recruitable stroke-work (contractility); EDPVR, end-diastolic PV relationship (diastolic stiffness). British Journal of Anaesthesia 2009 103, 654-664DOI: (10.1093/bja/aep238) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 4 Cardio-circulatory, LV systolic and diastolic function endpoints, comparing the IR and the time-control groups for desflurane. Data are presented as mean (sem). P=NS for all group×time interactions (RM-anova with the Greenhouse–Geisser correction). HR, heart rate; MAP, mean arterial pressure; CI, cardiac index; SVRI, systemic vascular resistance index; PRSW, preload-recruitable stroke-work (contractility); EDPVR, end-diastolic PV relationship (diastolic stiffness). British Journal of Anaesthesia 2009 103, 654-664DOI: (10.1093/bja/aep238) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 5 Cardio-circulatory, LV systolic and diastolic function endpoints, comparing the IR groups for propofol, sevoflurane, and desflurane. Data are presented as mean (sem). Significant differences were detected when individual comparisons were made between IR groups for group×time interaction for propofol and sevoflurane with respect to MAP and SVRI (RM-anova with the Greenhouse–Geisser correction and correction for multiple comparisons, sevIR vs propIR for MAP P′=0.012 and sevIR vs propIR for SVRI P′=0.036). Otherwise, P=NS for all other group×time interactions. HR, heart rate; MAP, mean arterial pressure; CI, cardiac index; SVRI, systemic vascular resistance index; PRSW, preload-recruitable stroke-work (contractility); EDPVR, end-diastolic PV relationship (diastolic stiffness). British Journal of Anaesthesia 2009 103, 654-664DOI: (10.1093/bja/aep238) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions