title: Myocardial ischemia and adverse cardiac outcomes in cardiac patients undergoing noncardiac surgery with sevoflurane and isoflurane. Sevoflurane Ischemia Study Group.
abstract: Sevoflurane is associated with less tachycardia and coronary vasodilation than isoflurane and thus might be associated with less myocardial ischemia. This multicenter study examined the incidence of myocardial ischemia and adverse cardiac outcomes in adults (40-87 yr) with cardiac disease having elective noncardiac surgery. Patients were randomized to receive either sevoflurane (S) (n = 106) or isoflurane (I) (n = 108) in conjunction with sodium thiopental, vecuronium, fentanyl, and 50%-70% N2O. Intraoperative hemodynamics were maintained within 20% of awake baseline with standard drugs. A Holter monitor was applied 3-24 h before surgery and maintained until 48 h after surgery. Electrocardiograms and blood samples for analysis of the MB isoenzyme fraction of creatine phosphokinase were obtained preoperatively and daily for 48 h postoperatively. Anesthetic exposure (1.79 +/- 0.15 [mean +/- SE] minimum alveolar concentration-hour) and duration of surgery (219 +/- 13 min) did not differ between groups. The incidence of ischemia in the pre-, intra- and postoperative periods, adverse cardiac outcomes (18% occurrence), intraoperative hemodynamic variations (+/-20% change from ward baseline), and administration of adjunct cardiovascular medications were similar between groups. In cardiac patients having noncardiac surgery, sevoflurane was comparable to isoflurane with respect to the incidence of intra- and postoperative myocardial ischemia and in the frequency of adverse cardiac outcomes.
  
  
  CONCLUSIONS
  Surgical patients with heart disease are at risk of heart complications, some of which could be induced by an anesthetic. We compared the incidence of cardiac complications between patients receiving sevoflurane and isoflurane. We found that the frequency of additional heart problems in cardiac patients receiving sevoflurane was not different from that associated with isoflurane.
authors.affiliation: Department of Anesthesiology, The Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee 53295, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Ebert
authors.forename: E D
authors.initials: ED
authors.lastname: Kharasch
authors.forename: G A
authors.initials: GA
authors.lastname: Rooke
authors.forename: A
authors.initials: A
authors.lastname: Shroff
authors.forename: M
authors.initials: M
authors.lastname: Muzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D003327:Coronary Disease / Q000139:chemically induced; D004987:Ethers / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D007431:Intraoperative Complications; D007530:Isoflurane / Q000009:adverse effects*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced*; D011183:Postoperative Complications; D012307:Risk Factors; D000077149:Sevoflurane; D013514:Surgical Procedures, Operative / Q000379:methods
chemical_list: D018685:Anesthetics, Inhalation; D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane