Cardiovascular and autonomic effects of sevoflurane

This review focuses on the effects of the newest volatile anesthetic, sevoflurane, on the cardiovascular system. In general, the cardiovascular effects of sevoflurane are quite similar to isoflurane but quite different from desflurane. Sevoflurane is not associated with increases in heart rate in adult patients and volunteers whereas higher MAC of isoflurane and desflurane and rapid increases in the inspired concentrations of these two agents have been associated with increased heart rates in unstimulated volunteers. Increasing concentrations of sevoflurane progressively decrease blood pressure and this decrease appears similar to isoflurane and desflurane. Sevoflurane is a less potent coronary vasodilator than isoflurane in rodents and it has not been associated with coronary steal in a dog model. Sevoflurane decreases myocardial contractility similar to equi-MAC concentrations of isoflurane and desflurane and does not potentiate epinephrine-induced cardiac arrhythmias. In several multi-center studies where patients with coronary artery disease or patients at high risk for coronary artery disease were randomized to receive either sevoflurane or isoflurane for cardiac or noncardiac surgery, the incidence of myocardial ischemia and infarction did not differ between treatment groups. Thus, sevoflurane has not been associated with untoward cardiovascular changes in volunteers and patients undergoing elective surgery and may have less potent effects on the vascular smooth muscle of select circulations.