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A-154
2002
Do Sevoflurane and Propofol Have Cardio-Protective Properties? A Study in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery
Peter F. Conzen, M.D.; Susanne C. Fischer, M.D.; Christian Detter, M.D.; Klaus Peter, M.D.
Ludwig-Maximilians-University, Institute of Anesthesiology, Munich, Germany
A variety of in vitro and animal studies have shown that volatile anesthetics have a protective effect on the myocardium during and after ischemia. The underlying mechanisms are still under investigation, but it appears that reduced polymorphonuclear neutrophil and platelet adhesion to the vascular endothelium contribute to the protective effect (1-3). We wondered if these beneficial effects could be reproduced in the perioperative human situation. Patients undergoing off-pump coronary surgery have a predictable and predefined ischemic zone during bypass grafting. In such patients we compared sevoflurane (S) versus propofol (P).

Methods:

23 patients scheduled for elective off-pump coronary surgery were randomized to receive anaesthesia consisting of sufentanil (0,025 μg/kg/min) combined with either propofol (2-5 μg/ml via target-controlled infusion) or sevoflurane (1 MAC). For analysis of Troponin I, CK, CK-MB, and Myoglobin blood was sampled before surgery (T1), immediately before ischemia (T2), 15min after ischemia (T3), at arrival on intensiv care unit (T4), as well as 3h (T5),6h (T6), 12h (T7), 18h (T8), 24h (T9) and 60h (T10) after admission on ICU.

Results:

Demographic patient data were not different. 10 patient received sevoflurane and 10 patients received propofol. Three patients met exclusion criteria, i.e. one patient (S) had excessive bleeding and one patient of each group suffered from severe hemodynamic instability so that cardiopulmonary bypass was necessary. During the postischemic measuring period Troponin I was significant lower with sevoflurane as compared to propofol (ANOVA (mean ± SD): 1,02 ± 1,03 vs. 1,5 ± 1,74 ng/ml, p=0,009). CK-MB was also lower with sevoflurane than with propofol, but this difference did not reach statistical significance (ANOVA (mean ± SD): 3,8 ± 3,7 vs. 4,1 ± 4,2 ng/ml, p=0,62). Myoglobin and CK were significantly higher with sevoflurane than with propofol (ANOVA (mean ± SD): 246 ± 293 vs. 175 ± 148 ng/ml (p=0,018) and 140 ± 178 vs. 93 ± 121 U/l (p=0,013)).

Cardiac index (CI) during sevoflurane increased from beginning to end of surgery from 2,3 ± 0,4 to 3,1 ± 0,6 l/min/m2 (p = 0,006), whereas CI remained constant with propofol 2,5 ± 0,7 vs. 2,7 ± 0,6 l/min/m2 (p = 0,599).

Conclusion:

Patients receiving sevoflurane during off-pump coronary surgery had significantly lower markers of myocardial injury (Troponin I and CK-MB) than patients receiving propofol. Moreover, myocardial function was better maintained and stunning apparently less pronounced, as cardiac output improved with sevoflurane but not with propofol. This study supports the experimental findings of cardio-protective effects by volatile anesthetics.

(1) Kowalski, C et al.: Anaesthesiology 1997; 86: 188-95

(2) Heindl, B et al.: Acta Anaesthesiol. Scand. 1998; 42: 995-1003

(3) Cope, D et al.: Anesthesiology 1997; 86: 699-709

Anesthesiology 2002; 96: A154