Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Abstract

ÖZETAmaç: Bu prospektif randomize çalışmanın amacı sevofluran ve isofluranın koroner baypas cerrahisi sırasında miyokart üzerindeki koruyucu etkilerini karşılaştırmaktır. Yöntemler: Etomidat (0.3 mg /kg ) ile genel anestezi indüksiyonunu takiben 0.1 mg/kg pankuronyum ve 1 mikrogr/kg remifentanil bolus olarak verildi. Anestezi idamesi Grup 1'deki hastalarda (n=20) %2-4 değerinde sevofluran, Grup 2'deki hastalarda (n=20) %1-2 değerinde isofluranla sağlandı. Anestezi indüksiyonundan önce, aortik klemp kaldırıldıktan sonra ve postoperatif periyotta arteriyel kan örnekleri alındı. Bu örneklerde Troponin T, kreatinin kinaz ve kreatinin kinaz MB değerleri ölçüldü. İstatistiksel analizler -iki-yönlü ANOVA ve Mann-Whitney testleri ile yapıldı. Bulgular: Kalp hızı sevofluran grubunda pompa periyodunda, pompadan çıkış sonrası 10. ve 20. dakikalarda anlamlı yüksek bulunmuştur. CKMB düzeyi postoperatif 24. saatte sevofluran grubunda isofluran grubuna göre anlamlı düşüktür. Troponin T kros-klemp kaldırıldıktan sonra (1.015 (0.935-1.850) ng/ml, 1.469 (1.290-1.645) ng/ml, p<0.001) ve postoperatif 24.saatte (5.345±0.654 ng/ml, 8.715±1.020 ng/ml, p<0.001) sevofluran grubunda isofluran grubu ile karşılaştırıldığında anlamlı düşüktür. Sonuç: Miyokardiyal hasarlanma işaretleyicileri olan troponin T ve CKMB düzeylerinin daha düşük düzeylerde saptanması ile sevofluranın isoflurana göre miyokardiyal korumayı daha iyi sağlamakta olduğu kanısındayız. (Anadolu Kardiyol Derg 2011; 11: 257-62) Anahtar kelimeler: Sevofluran, isofluran, miyokardiyal koruma, koroner baypas cerrahisi ABSTRACT Objective: The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. Methods: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2%. Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. Results: Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10 th minute and 20 th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24 th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24 th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. Conclusion: Sevoflurane provides a better myocardial protection than isof...

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