Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: A pilot study

Abstract

Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery.

New-Onset Atrial Fibrillation After Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment

“…It has been shown that some drugs and techniques may lead to the reduction of POAF (Table 3) [119][120][121][122][123][124][125][126][127][128][129][130][131].…”

“…Table 3. Drugs and interventions that might reduce the incidence of postoperative atrial fibrillation High thoracic epidural anesthesia [119] Volatile anesthetics [120] Glucose-insulin-potassium solution [121] Levosimendan [122] Dexmedetomidine [123] N-acetylcysteine [124] Triiodothyronine [125] Vitamin C [126] Miniaturized cardiopulmonary bypass systems [127] Off-pump surgery [128] Leukocyte depletion [129] Minimizing blood transfusions [130] Temperature management during perfusion [131] …”

Myocardial conditioning techniques in off-pump coronary artery bypass grafting

“…No differences in troponin release were reported by other authors when sevoflurane was compared to desflurane and propofol [ 28 ], to propofol in a remifentanil - based anesthesia regime [ 29 , 30 ] and to isoflurane alone [ 31 , 32 ]. Sevoflurane was also showed to have several other benefits: better antioxidative properties than propofol [ 33 ], reduced incidence of arrhythmias compared to desflurane [ 34 ], better preservation of cardiac function compared to control and to propofol [ 35 , 36 ] and to reduced NBP release and plasma protein A release when compared to propofol [ 37 ]. Isoflurane was reported to reduce troponin release when compared to propofol [ 38 ] but no differences were found when compared to sevoflurane [ 31 , 32 ].…”

“…Other authors on the contrary did not find differences in terms of troponin release when it was compared to a propofol group of patients [ 39 ]. Desflurane was reported to improve LSWI when compared to a propofol anesthetic regime, although no differences in troponin release were observed [ 40 ], and moreover was found to be less effective in reducing incidence of arrhythmias than sevoflurane [ 34 ]. Guarracino et al observed a significant reduction in troponin release in a cohort of 57 patients anesthetized with desflurane [ 41 ].…”

“…Sevoflurane is proven to reduce troponin level after on-pump surgery but its effect is still unclear in the off-pump scenario. With regard to OPCAB, sevoflurane was found to preserve cardiac function in three studies [ 35 , 37 , 54 ], to reduce troponin release in two studies [ 26 , 27 ], to have antioxidant properties in one [ 33 ] and to prevent incidence of arrhythmias in one [ 34 ]. On the contrary sevoflurane did not show any better troponin reduction when compared to other agents in four studies [ 28 - 31 ].…”