Myocardial Damage Prevented by Volatile Anesthetics: A Multicenter Randomized Controlled Study

Guarracino, Fabio; Landoni, Giovanni; Tritapepe, Luigi; Pompei, F.; Leoni, Albino; Aletti, Giacomo; Scandroglio, Anna Mara; Maselli, Daniele; Luca, Monica De; Marchetti, Chiara; Crescenzi, Giuseppe; Zangrillo, Alberto

doi:10.1053/j.jvca.2006.05.012

Cited by 140 publications

(94 citation statements)

References 29 publications

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“…We did not observe a significant effect of desflurane on blood concentrations of markers of myocardial ischaemia: troponin I and CK-MB. Earlier studies demonstrated conflicting results: a decreased concentration after volatile anaesthesia [12,14], or no effect [10,[15][16][17][18]. In two studies published recently, late postconditioning with sevoflurane used for sedation after coronary surgery also did not provide reduction of troponin release [19,20].…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Mroziński

Lango²,

Biedrzycka³

et al. 2014

Anaesthesiol Intensive Ther

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Background: Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery. Methods: Design: Prospective randomised open-label study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume. Results: No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: -14.3 and -19.8 [g m m -2 beat -1 ]), respectively (P = 0.029). Oxygen uptake index (VO 2 I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration. Conclusions: This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism. Clinical trial registration information: NCT00528515

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Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Mroziński

Lango²,

Biedrzycka³

et al. 2014

Anaesthesiol Intensive Ther

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“…Many studies (11)(12)(13)(14)(15)(16)18,19) and reviews (21)(22) have appeared in the literature suggesting a cardioprotective effect provided by volatile anesthetics in patients undergoing cardiac procedures. A recent survey (23) conducted in 64 Italian centres, encompassing a total of 34,310 patients undergoing coronary artery bypass graft surgery, showed that risk-adjusted mortality may be reduced by the use of volatile agents.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane vs propofol in high risk cardiac surgery: design of the randomized trial “Sevo-Aifa”

Landoni

Guarracino

Baldassarri

et al. 2011

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“…Preconditioning limits myocardial damage and results in better myocardial performance, fewer days in the intensive care unit 8,51 as well as improved one year survival rates. 52 However, inhaled anesthetic agents appear to do this reliably only if administered before, during and after aortic clamping, similar to the protocol used in this study.…”

Section: The Effectiveness Of the Global Circulation After Bypassmentioning

confidence: 99%

“…[4][5][6] Techniques making use of an opioid in combination with either an inhaled anesthetic agent or infusions of propofol, are used to achieve these goals. [7][8][9] If the correct combination is employed, the deleterious circulatory effects of any one agent may be avoided, and optimal myocardial oxygen supply-demand balance may be facilitated.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, early experimental work on animals [10][11][12] and more recently in humans 8,[13][14][15] has shown that inhaled anesthetic agents, but not propofol, if administered both before aortic clamping and on reperfusion, reliably limit the degree of myocardial injury after cardiac surgery. 16 This study was designed to compare hemodynamics, circulatory efficiency, myocardial ischemia and explicit recall, when using either sevoflurane or halothane, in combination with sufentanil, for coronary artery bypass graft surgery.…”

Section: Introductionmentioning

confidence: 99%

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Sevoflurane or halothane with target-controlled sufentanil infusions for coronary artery bypass surgery

Levin

Coetzee

Coetzer³

et al. 2007

Southern African Journal of Anaesthesia and Analgesia

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ObjectivesComparison of hemodynamics, circulatory efficiency, myocardial ischemia and recall during and after sevoflurane or halothane (0.6 MAC {Minimum Alveolar Concentration} inspired) combined with a target-controlled sufentanil infusion (2 ng.ml -1 ) for coronary artery bypass grafting. MethodsProspective randomised non-blinded study in a university teaching hospital of 45 patients undergoing on-pump surgery. Inhalation anesthetic agent was delivered before, during and after cardiopulmonary bypass. ResultsIntraoperative hemodynamics were maintained within predetermined limits using vasoactive and cardioactive drugs. Heart rate was unchanged from baseline, however the sevoflurane-sufentanil group required more glycopyrrollate, indicating a tendency towards a slower heart rate. In both groups, similar low incidences of myocardial ischemia were detected. After induction of anesthesia, as well as intraoperatively, oxygen consumption decreased by up to 36.6% compared with the awake values in both groups. Oxygen delivery remained unchanged during all measuring periods. Mixed venous oxygen tensions rose after induction, even in patients with cardiac indices below 2.2 L.min -1 .m -2 , indicating maintenance of an effective circulation when utilising these techniques. Twelve hours postoperatively, oxygen consumption exceeded awake values by 31%. No explicit recall was reported by any patient on enquiry on the third postoperative day. ConclusionsLow concentrations of sevoflurane or halothane, supplementing target-controlled sufentanil infusions, were both suitable for providing anesthesia for coronary bypass surgery.

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Myocardial Damage Prevented by Volatile Anesthetics: A Multicenter Randomized Controlled Study

Cited by 140 publications

References 29 publications

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Sevoflurane vs propofol in high risk cardiac surgery: design of the randomized trial “Sevo-Aifa”

Sevoflurane or halothane with target-controlled sufentanil infusions for coronary artery bypass surgery

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