Comparison the Cerebroprotective Effect of Sevoflurane and Propofol in Patients with Carotid Artery Stenosis Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Study

Abstract

Objective: The Objective of the study was to evaluate the perioperative cerebral protective effect of sevoflurane and propofol in patients with carotid artery stenosis undergoing coronary artery bypass grafting. Materials and Methods: A randomized clinical study included 200 patients with preoperative carotid artery stenosis <50% scheduled for cardiac surgery with cardiopulmonary bypass. The patients were classified into 2 groups (each=100), Sevoflurane group: The patients received sevoflurane (concentration 1% to 4%) as an inhalational agent. Propofol group: The patients received propofol infusion (4-6 mg/kg/hr). The sevoflurane and propofol were given during the whole procedure (before, during, and after cardiopulmonary bypass). The monitors included heart rate, mean arterial blood pressure (MAP), central venous pressure and cerebral near-infrared spectroscopy (NIRS), the incidence of postoperative cognitive dysfunction and stroke. Results: There was no significant difference in the perioperative heart rate, mean arterial blood pressure, central venous pressure, and the right or left regional cerebral oxygen saturation between the two groups (P>0.05). The incidence of postoperative neurological complication was significantly lower with sevoflurane than propofol (P=0.012). The incidence of delirium was significantly lower with sevoflurane than propofol (P=0.023). The incidence of stroke was lower with sevoflurane than propofol, but the difference was insignificant (P=0.682). The ICU and hospital length of stay were shorter with sevoflurane than propofol (P=0.013, P=0.033 respectively). Conclusions: The sevoflurane was associated with a lower incidence of postoperative cognitive dysfunction than propofol in patients with carotid artery stenosis undergoing coronary artery bypass grafting.