Hemodynamic Effects of Propofol vs. Sevoflurane in Cardiac Anesthesia

Abstract

Introduction: Propofol total intravenous anesthesia (TIVA) and sevoflurane volatile anesthesia are both used in cardiac surgery, but their hemodynamic profiles during cardiopulmonary bypass (CPB) differ. This review compares their effects on myocardial depression and vasodilation.
Methods: A literature review (2015–2024) of RCTs comparing propofol and sevoflurane in adults undergoing coronary artery bypass grafting or valve surgery. Primary outcomes: mean arterial pressure (MAP) drop during induction, vasopressor requirement, and cardiac index post-CPB.
Results: Ten RCTs (n=1,204) were analyzed. Propofol caused a greater MAP reduction at induction (Δ -22 mmHg vs. -14 mmHg, p=0.003) and required 1.5× more norepinephrine. Sevoflurane preserved cardiac index better post-CPB (2.8 vs. 2.4 L/min/m², p=0.01). Myocardial injury biomarkers were similar.
Discussion: Sevoflurane’s ischemic preconditioning effect may explain better post-CPB hemodynamics, while propofol’s direct vasodilation and negative inotropy are more pronounced. Both agents are safe, but sevoflurane offers advantages in patients with poor ventricular function.
Conclusions: Sevoflurane provides superior intraoperative hemodynamic stability compared to propofol in cardiac anesthesia. Choice should be individualized based on baseline ventricular function and risk of hypotension.