Sevoflurane but Not Propofol Preserves Myocardial Function in Coronary Surgery Patients

Hert, S. G. De; Broecke, Pieter W. ten; Mertens, E.; Sommeren, Esther W. Van; Blier, Ivo G. De; Stockman, Bernard; Rodrigus, Inez

doi:10.1097/00000542-200207000-00007

Cited by 299 publications

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“…This contrasts with reports where total intravenous anesthesia with propofol and remifentanil was used for cardiac surgery. 17 Consistent with our definition of cardiac depression, we did not observe a decrease in CI across dosing groups upon emergence from CPB. This pattern was associated with a decrease in SVRI and the maintenance of LVSWI (Fig.…”

Section: Discussionsupporting

confidence: 84%

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Raedschelders

Laferlita

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Propofol concentrations that produce laboratory-based cardioprotective effects are generally greater than those produced under routine anesthesia during cardiac surgery. It is unknown whether experimental cardioprotective propofol concentrations can routinely be achieved during cardiopulmonary bypass (CPB) using continuous infusion. Methods Twenty-four patients scheduled for primary aortocoronary bypass grafting with CPB were allocated to receive one of three propofol infusion rates; 50, 100, or 150 lg Á kg -1 Á min -1 in an open-label pilot study. Data were described using a line of best fit to derive an experimental clinical maneuver predicted to produce a whole blood concentration of 5 lg Á mL -1 at reperfusion. A predetermined interim analysis of 30 patients who were receiving the derived maneuver in an ongoing study was used to evaluate the maneuver. Cardiac index (CI), systemic vascular resistance index (SVRI), and left ventricular stroke work index (LVSWI) were recorded. Results The infusion rate-concentration curve had an equation of y = 0.215e 0.0279x , where y represents the whole blood concentration and x represents the infusion rate (r 2 = 0.781). The predicted infusion rate to achieve a mean concentration of 5 lg Á mL -1 was 113 lg Á kg -1 Á min -1 . The nearest practical rate is 120 lg Á kg -1 Á min -1 , producing a concentration of 5.39 (1.45) lg Á mL -1 . The values for CI, SVRI, and LVSWI were similar between groups at corresponding time periods. Conclusions An infusion rate of 120 lg Á kg -1 Á min -1 is clinically practical and capable of achieving experimental cardioprotective propofol concentrations at reperfusion. RésuméObjectif Les concentrations de propofol qui provoquent des effets cardioprotecteurs lors des tests de laboratoire sont en ge´ne´ral plus e´leve´es que celles produites sous une anesthe´sie de routine lors d'une chirurgie cardiaque. Nous ne savons pas si des concentrations expe´rimentales cardioprotectrices de propofol peuvent eˆtre atteintes de façon routinie`re pendant la circulation extracorporelle (CEC) avec une perfusion continue. Méthode Vingt-quatre patients devant subir un pontage aortocoronarien avec CEC ont e´te´randomise´s à recevoir l'un des trois vitesses de perfusion de propofol suivantes : 50, 100 ou 150 lgÁkg -1 Ámin -1 dans une e´tude pilote ouverte. Les donne´es ont e´te´de´crites a`l'aide d'une droite de re´gression afin de de´river une manoeuvre clinique expe´rimentale qui devrait produire une concentration de sang total de 5 lgÁmL -1 au moment de la reperfusion. Une

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Section: Discussionsupporting

confidence: 84%

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Raedschelders

Laferlita

et al. 2009

Can J Anesth/J Can Anesth

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“…133 Volatile anesthetics (sevoflurane, isoflurane, and desflurane) have, in several experimental and clinical settings, been shown to protect the heart from I/R injury. [134][135][136][137] Recently, isoflurane was demonstrated to have a similar effect on the rat liver, 138 and sevoflurane, in a prospective randomized study, protected the human liver from I/R injury during liver resection. 139 It is our practice to administer volatile anesthetics at least during the last 30 min before aortic cross clamping.…”

Section: Pulmonary Carementioning

confidence: 97%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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“…Sevoflurane also appears to exhibit cardioprotective effects against reperfusion injury, and this effect has been attributed to its free radical scavenging properties and the reduction of postischemic adhesion of neutrophils. 31,32 Recently, a small study comparing sevoflurane with propofol showed that sevoflurane was superior to propofol in terms of reperfusion injury and contractile function in humans, 33 although the two groups were not homogenous with respect to preoperative ejection fraction and the number of surgical techniques. In our study, in animals anesthetized with propofol, we observed lower plasma inflammatory cytokine levels, these being able to stimulate and increase neutrophil infiltration.…”

Section: Discussionmentioning

confidence: 99%

Laboratory investigation: Effects of propofol on the systemic inflammatory response during aortic surgery

Rodríguez-López

Conde

Lozano

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: A laboratory investigation was undertaken to assess the effects of propofol on renal function, through modulation of the systemic inflammatory response, in an in vivo experimental model of aortic surgery in comparison with sevoflurane.Methods: Twenty young male piglets were anesthetized with either propofol 4 mg·kg -1 ·hr -1 (n = 10) or sevoflurane 1.5% end-tidal concentration (n = 10). Animals were subjected to aorta-aortic bypass with suprarenal aortic clamping for 30 min. At specific intervals (basal -before the start of surgery; reperfusion 15 min after unclamping the aorta; at 24, 48 and 72 hr after surgery, and on the seventh day after surgery) the levels of the following were determined: plasma creatinine, renal myeloperoxidase, tumour necrosis factor-α, interleukin 1-ß, and interferon-γ; kidney superoxide anion and its detoxifying enzyme superoxidase dismutase, kidney malondialdehyde and the activity of inducible nitric oxide synthase. Seven days after surgery, the animals were anesthetized using the described techniques, and after blood withdrawal and kidney sampling they were sacrificed. Results:In comparison with sevoflurane, propofol was associated with a lower concentration of plasma creatinine (P < 0.05) together with lower concentrations of myeloperoxidase, tumour necrosis factor-α, interleukin 1-ß, interferon-γ, superoxide anion and superoxidase dismutase, malondialdehyde and inducible nitric oxide synthase (P < 0.05). Conclusion:In an experimental model of aortic reconstructive surgery, and compared with sevoflurane, propofol anesthesia is associated with less neutrophil infiltration, lower plasma proinflammatory cytokine levels, lower production of oxygen free radicals, less lipid peroxidation, and reduced inducible nitric oxide synthase activity. These observations suggest a possible renal protective effect of propofol in this surgical setting. Objectif

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Sevoflurane but Not Propofol Preserves Myocardial Function in Coronary Surgery Patients

Abstract: Sevoflurane preserved LV function after CPB with less evidence of myocardial damage in the first 36 h postoperatively. These data suggest a cardioprotective effect of sevoflurane during coronary artery surgery.

Cited by 299 publications

References 0 publications

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study

Brain death and its implications for management of the potential organ donor

Laboratory investigation: Effects of propofol on the systemic inflammatory response during aortic surgery

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