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A-155
2002
Effects of Sevoflurane and Propofol on Procalcitonin and C-Reactive Protein Concentrations in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery
Susanne C. Fischer, M.D.; Peter F. Conzen, M.D.; Joerg M. Schmoeckel, M.D.; Klaus Peter, M.D.
Ludwig-Maximilians-University, Institute of Anesthesiology, Munich, Germany
Cardiac surgery using cardiopulmonary bypass is often associated with severe inflammatory reactions (e.g.SIRS), which can lead to multi-organ failure and increased postoperative morbidity and mortality (1). Elevated systemic inflammatory markers have also been reported following off-pump coronary artery bypass graft procedures (OPCAB) (2). Sevoflurane is known to modulate the interaction of polymorphonuclear neutrophils with the coronary microvascular endothelium and this may play a crucial role in the initiation of reperfusion injury (3). We evaluated the influences of anesthesia regimens based on sevoflurane (S) and on propofol (P) on the perioperative serum concentrations of procalcitonon (PCT) and C-reactive protein (CRP) in patients undergoing elective off-pump coronary surgery.

Methods:

23 patients undergoing elective cardiac surgery were randomized to receive anesthesia consisting of either propofol (2-5 μg/ml in target-controlled infusion) or sevoflurane (1 MAC) supplemented by sufentanil (0,025 μg/kg/min). Blood samples were taken before surgery (T1), following exposure of the coronary arteries (T2), 15min after ischemia (T3) , at arrival on intensiv care unit (T4) as well as 3h (T5),6h (T6), 12h (T7), 18h (T8) and 24h (T9) after admission on ICU. All patients were intensely monitored and carefully controlled to avoid instability such as systemic hypotension, tachycardia or myocardial ischemia.

Results:

Analyses were done in 10 patients receiving sevoflurane and 10 patients receiving propofol. Three patients met exclusion criteria, i.e. one patient (S) had excessive bleeding and one patient in each group displayed severe hemodynamic instability so that cardiopulmonary bypass was necessary for successful surgery. Total duration of surgery in these patients was 228 ± 81 (S) and 243 ± 69 min (P), respectively (n.s.).

Times to extubation and to discharge from hospital were 485 ± 233 (S) and 570 ± 313 min (P) (n.s.) and 12 ± 3 (S) and 16 ± 9 days (P) (n.s.), respectively.

PCT serum concentrations increased slightly more with propofol than with sevoflurane (ANOVA (mean ± SD): 0,38 ± 0,5 (P) vs. 0,28 ± 0,8 (S) ng/ml, p = 0,263). In contrast, CRP increased significantly more after propofol than after sevoflurane (ANOVA (mean ± SD): 6,0 ± 7,4 (P) vs. 5,1 ± 6,7 (S) mg/dl, p = 0,002).

Conclusion:

An anesthesia regimen based on sevoflurane suppressed to some extent the perioperative release of CRP and PCT compared to an anesthesia regimen based on propofol. Characterized by relatively long serum half-life times both inflammation markers reflect the cumulative systemic inflammatory response. We conclude that sevoflurane in accordance to the experimental findings mitigates the inflammatory response.

(1) Cremer, J et al.: Ann. Thorac. Surg. 1996; 61: 1714-20

(2) Kilger, E et al.: Thorac. Cardiovasc. Surg. 1998; 46:130-33

(3) Heindl, B et al.: Anesthesiology 1999; 91:521-530

Anesthesiology 2002; 96: A155