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CARDIOVASCULAR ANESTHESIA

Propofol Decreases Reperfusion-Induced Arrhythmias in a Model of "Border Zone" Between Normal and Ischemic-Reperfused Guinea Pig Myocardium

Jean-Luc Hanouz, MD PhD^*, Alexandra Yvon, BSc, Frédéric Flais, MD^*, René Rouet, PhD, Pierre Ducouret, PhD, Henri Bricard, MD^*, and Jean-Louis Gérard, MD PhD^*,

*Department of Anesthesiology, Centre Hospitalier Universitaire Caen, Caen, France; and Laboratory of Experimental Anesthesiology and Cellular Physiology, Centre Hospitalier Universitaire Caen, Caen, France

Address correspondence and reprint requests to Jean-Luc Hanouz, MD, PhD, Département d’Anesthésie-Réanimation, CHU de Caen, Avenue Côte de Nacre, 14033 Caen Cedex, France. Address e-mail to hanouz-jl{at}chu-caen.fr

We examined the effect of propofol on the main mechanisms involved in ischemia/reperfusion-induced arrhythmias (i.e., spontaneous arrhythmias, conduction blocks, and dispersion of repolarization) in vitro. In a double-chamber bath, guinea pig right ventricular muscle strips were subjected to 30 min of simulated ischemia followed by 30 min of reperfusion (altered zone; AZ) and to standard conditions (normal zone; NZ). Action potential (AP) parameters were recorded in the NZ and AZ. We studied the effects of Intralipid® and of propofol at 10^-6, 10^-5, and 2 x 10^-5 M on the occurrence of spontaneous sustained arrhythmias, conduction blocks, and the dispersion of repolarization. In NZ, Intralipid and propofol did not significantly modify the AP parameters. Propofol, but not Intralipid, lessened the ischemia-induced decrease in AP duration (APD) at 90% of repolarization (APD₉₀) and attenuated the APD dispersion around the "border zone." Propofol did not modify the occurrence of ischemia-induced arrhythmias. Propofol 10^-6 M, but not Intralipid or propofol at 10^-5 and 2 x 10^-5 M, decreased the occurrence of ischemia-induced conduction blocks. Propofol decreased the occurrence of reperfusion-induced spontaneous sustained arrhythmias. We conclude that, in vitro, propofol attenuated the ischemia-induced APD₉₀ dispersion around the "border zone" and decreased the occurrence of spontaneous arrhythmias related to myocardial reperfusion injury.

IMPLICATIONS: In isolated guinea pig ventricular myocardium propofol, but not Intralipid®, attenuated the ischemia-induced shortening of action potential and, thus, the dispersion of repolarization and decreased the occurrence of spontaneous ventricular arrhythmia related to reperfusion injury. This result may be important for propofol-based anesthesia in patients at high risk for intraoperative ischemia.