Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels

Abstract

P Pu ur rp po os se e: : Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100ß protein and neuropsychological tests after coronary artery bypass grafting (CABG).M Me et th ho od ds s: : Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group P. Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100ß protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24 th hr postoperatively (T5).R Re es su ul lt ts s: : Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P, S-100ß protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05).C Co on nc cl lu us si io on ns s: : Despite reports about the neuroprotective effects of propofol, S-100ß protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients. C Ca ar rd di io ot th ho or ra ac ci ic c A An ne es st th he es si ia a, , R Re es sp pi ir ra at ti io on n a an nd d A Ai ir rw wa ay y Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels [L'anesthésie au propofol, comparé à l'isoflurane, n'a Objectif : Malgré les progrès de l'anesthésie, la circulation extracorporelle (CEC) et les techniques chirurgicales, les lésions cérébrales demeurent une importante source de morbidité postchirurgie cardiaque. Les effets neurologiques comparés de l'isoflurane et du propofol sont présentés par l'analyse des protéines sériques S-100ß et des test neuropsychologiques après un pontage aortocoronarien (PAC). Méthode : Notre étude préliminaire, prospective et contrôlée a porté sur 20 patients, répartis au hasard en deux groupes, qui devaient subir un PAC. L'isoflurane a été utilisé dans le groupe I et le propofol dans le groupe P. L'examen neurologique et une batterie de tests neuropsychologiques, comprenant le mini-examen de l'état mental (MMSET pour mini mental state examination) et le test visuel et auditif de mémoire des chiffres (VADST pour visual aural digit span test), ont été réalisés avant l'opérat...

Recovery of older patients undergoing ambulatory anaesthesia with isoflurane or sevoflurane

“…The digit repetition forward (DRF) and digit repetition backward (DRB) tests were used to assess attention, alertness, concentration and short-term memory [12][13][14]. These clinical tests assess immediate serial recall by the patient of a list of digits spoken by the investigator.…”

“…These clinical tests assess immediate serial recall by the patient of a list of digits spoken by the investigator. In DRF patients repeat digits in the same order as they are presented, and in DRB they repeat them in reverse order [12][13][14]. These tests were carried out preoperatively on the morning of or evening before surgery to determine the baseline cognitive function, and postoperative tests were carried out at 1, 3 and 6 h. Both sets of tests were carried out by the same blinded investigator.…”

Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis

“…[17][18][19] All the articles had reported exclusion/inclusion criteria. [17][18][19][20][21][22][23][24][25][26][27][28][29] Of these, seven studies had used isoflurane versus TIVA, 17 19-21 23 24 27 four studies Open Access had used sevoflurane versus TIVA 18 22 25 26 and two studies had used desflurane versus TIVA 28 29 in patients.…”

Neurocognitive dysfunction after cardiac surgery and biochemical markers

“…[52] propofol ve isofluranın nöropro-tektif etkisini karşılaştırdıkları çalışmada, KPB sırasın-da S100b düzeyinin isofluran uygulanan grupta anlamlı artış göstermemesine rağmen propofol infüzyonu kullanılan grupta belirgin olarak arttığı gözlenmiştir. Fakat ameliyat sonrası birinci günde iki gruptaki düzeyler benzer gerçekleşmiştir.…”