Propofol does not inhibit hypoxic pulmonary vasoconstriction in humans

An anesthesiologist's guide to hypoxic pulmonary vasoconstriction: implications for managing single-lung anesthesia and atelectasis

“…Lidocaine has been reported to enhance HPV (at high doses) [15]. Other strategies that preserve HPV include high-frequency positive-pressure ventilation [16].…”

“…halothane [2]) decrease HPV, whereas others do not (enflurane and isoflurane [17,18]) (Table 1). One can avoid suppressing HPV by choosing certain intravenous agents for anesthesia (e.g., propofol [12,13,16] or fentanyl [19]), and/or using spinal anesthetic [9,10] (Table 1). Lidocaine has been reported to enhance HPV (at high doses) [15].…”

Propofol in patients with cardiac disease

“…Propofol in contrast to halogenated agents does not inhibit hypoxic pulmonary vasoconstriction in patients undergoing leftsided thoracotomy. 40 These studies inferred that the haemodynamic depression observed with propofol could be attributed primarily to alterations in peripheral arterial and/or venous tone. Despite these well-designed studies, other investigators have found SVR to be unchanged, 14,30,31,41 while Naeije et al 42 reported that vascular tone was related to the concentration of oxygen.…”

Clinical Pearls in Anaesthesia for Pleurectomy/Decortication for Malignant Mesothelioma

“…HPV inhibitors include volatile anesthetics (halothane and enflurane >isoflurane, sevoflurane and desflurane)systemic vasodilators (nitroglycerin, sodium nitroprusside, dobutamine, calcium channel blockers, and β2 agonists), pulmonary artery pressure extremes, hypocapnia, mixed venous oxygen tension extremes and pulmonary infection [9,10]. We employed less than one MAC of sevoflurane supplemented by a BIS-guided propofol infusion during OLV to prevent awareness since propofol does not inhibit HPV [11]. Factors decreasing blood flow to ventilated lung (high peak or mean airway pressures, high PEEP), hyperventilation, low fraction of inspired oxygen (FiO 2 ), vasoconstrictors (dopamine, epinephrine, and phenylephrine) causing greater vasoconstriction of normoxic vessels than hypoxic vessels were factors which we avoided.…”