Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass

Abstract

BackgroundThis study aimed to compare myocardial protective effects of anaesthesia with intravenous infusion of propofol versus inhalation of sevoflurane in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.MethodsSeventy-six patients undergoing valve replacement with cardiopulmonary bypass were randomly assigned to propofol or sevoflurane anesthesia during the surgery, respectively. For assessing myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme (CK-MB) were determined before induction (T0), 0.5 h (T1) and 3 h (T2) after aortic unclamping, and 24 h (T3) and 48 h (T4) after surgery. The concentrations of interleukin (IL)-6 and IL-10 as the systemic inflammatory and anti-inflammatory markers were also measured at above time points.ResultsIn the sevoflurane group, the plasma concentrations of cTnI and CK-MB from Tl to T4 and the levels of IL-6 and IL-10 from T1 to T2 were lower than those in the propofol group. Moreover, a higher ratio of automatic heart beat recovery and a shorter length of intensive care unit or hospital stay were found in the sevoflurane group comparing with the propofol group.ConclusionSevoflurane anaesthesia produced more prominent myocardial protection and attenuated inflammatory response than propofol anaesthesia in patients with valve replacement surgery under cardiopulmonary bypass, resulting in shorter ICU and in-hospital stay.Retrospective clinical trial registrationIdentified as ChiCTR-IOR-16009979 at http://www.chictr.org.cn/.

Comparison of the expression of cluster of differentiation (CD)39 and CD73 between propofol- and sevoflurane-based anaesthesia during open heart surgery

“…Several studies have shown the beneficial effects of volatile anaesthetics relative to propofol during cardiac surgery 19 , 20 , indexed by lower creatine kinase-MB (CK-MB) levels with volatile anaesthetics compared to propofol-based anaesthesia. However, cardiac enzymes do not guarantee immune status during OHS since they are associated only with myocardial injury related to surgical trauma 21 .…”

The Effect of Anesthesia Depth on Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Retrospective Study

“…At clinically relevant concentrations, the incidence of arrhythmia is relatively low, but the effect of arrhythmia inhibition is more signi cant. Studies have demonstrated that propofol has a protective effect on myocardial ischemia and arrhythmia which are caused by ischemia-reperfusion injury [11][12] . Propofol also has been shown to terminate atrial brillation and VT storm [13][14] .…”

“…Similarly, sevo urane may also affect the induction of VT, which mainly produces a cascade reaction through a variety of signal transduction pathways such as protein kinase C, tyrosine protein kinase, etc., changing the gene expression of cardiomyocytes, and producing a variety of anti-injury factors. Furthermore, sevo urane also prevents intracellular calcium overload through KATP channels, reduces ischemia-reperfusion injury and produces cellular protection [12] , so as to decrease the occurrence of ventricular arrhythmias. In addition, sevo urane and other volatile anesthetics can also delay atrioventricular repolarization and reduce the possibility of inducing ventricular arrhythmia in vitro by prolonging the duration of the action potential, but its clinical signi cance is not clear.…”

Sevoflurane pretreatment attenuates hypoxia/reoxygenation-induced cardiomyocyte apoptosis through activation of AKT/pim-1 and AKT/GSK3β signaling pathways

“…Volatile anesthetic agents have the potential to provide myocardial protection by anesthetic preconditioning [4]. The volatile anesthetic sevoflurane is typically used in general anesthesia for patients undergoing surgery, including heart surgery [5,6]. However, the precise mechanism of sevoflurane's role in cardio-protection has not been elucidated.…”