Sevoflurane but not propofol preserves myocardial function in coronary surgery patients.
BACKGROUND
Sevoflurane has been shown to protect against myocardial ischemia and reperfusion injury in animals. The present study investigated whether these effects were clinically relevant and would protect left ventricular (LV) function during coronary surgery.


METHODS
Twenty coronary surgery patients were randomly assigned to receive either target-controlled infusion of propofol or inhalational anesthesia with sevoflurane. Except for this, anesthetic and surgical management was the same in all patients. A high-fidelity pressure catheter was positioned in the left ventricle and the left atrium. LV response to increased cardiac load, obtained by leg elevation, was assessed before and after cardiopulmonary bypass (CPB). Effects on contraction were evaluated by analysis of changes in dP/dt(max). Effects on relaxation were assessed by analysis of the load dependence of myocardial relaxation (R = slope of the relation between time constant tau of isovolumic relaxation and end-systolic pressure). Postoperative concentrations of cardiac troponin I were followed during 36 h.


RESULTS
Before CPB, leg elevation slightly increased dP/dt(max) in the sevoflurane group (5 +/- 3%), whereas it remained unchanged in the propofol group (1 +/- 6%). After CPB, leg elevation resulted in a decrease in dP/dt(max) in the propofol group (-5 +/- 4%), whereas the response in the sevoflurane group was comparable to the response before CPB (5 +/- 4%). Load dependence of LV pressure fall (R) was similar in both groups before CPB. After CPB, R was increased in the propofol group but not in the sevoflurane group. Troponin I concentrations were significantly lower in the sevoflurane than in the propofol group.


CONCLUSIONS
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.
De Hert
Stefan G
SG
Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium. sdehert@uia.ac.be
ten Broecke
Pieter W
PW
Mertens
Els
E
Van Sommeren
Esther W
EW
De Blier
Ivo G
IG
Stockman
Bernard A
BA
Rodrigus
Inez E
IE
D000368:Aged; D000777:Anesthetics / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D020011:Protective Agents / Q000494:pharmacology*; D000077149:Sevoflurane; D016277:Ventricular Function, Left / Q000187:drug effects
D000777:Anesthetics; D008738:Methyl Ethers; D020011:Protective Agents; D000077149:Sevoflurane; D015742:Propofol