title: Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study.
abstract: BACKGROUND
  Preconditioning by volatile anesthetics is a promising therapeutic strategy to render myocardial tissue resistant to perioperative ischemia. It was hypothesized that sevoflurane preconditioning would decrease postoperative release of brain natriuretic peptide, a biochemical marker for myocardial dysfunction. In addition, several variables associated with the protective effects of preconditioning were evaluated.
  
  
  METHODS
  Seventy-two patients scheduled for coronary artery bypass graft surgery under cardioplegic arrest were randomly assigned to preconditioning during the first 10 min of complete cardiopulmonary bypass with either placebo (oxygen-air mixture only) or sevoflurane 4 vol% (2 minimum alveolar concentration). No other volatile anesthetics were administered at any time during the study. Treatment was strictly blinded to anesthesiologists, perfusionists, and surgeons. Biochemical markers of myocardial dysfunction and injury (brain natriuretic peptide, creatine kinase-MB activity, and cardiac troponin T), and renal dysfunction (cystatin C) were determined. Results of Holter electrocardiography were recorded perioperatively. Translocation of protein kinase C was assessed by immunohistochemical analysis of atrial samples.
  
  
  RESULTS
  Sevoflurane preconditioning significantly decreased postoperative release of brain natriuretic peptide, a sensitive biochemical marker of myocardial contractile dysfunction. Pronounced protein kinase C delta and epsilon translocation was observed in sevoflurane-preconditioned myocardium. In addition, postoperative plasma cystatin C concentrations increased significantly less in sevoflurane-preconditioned patients. No differences between groups were found for perioperative ST-segment changes, arrhythmias, or creatine kinase-MB and cardiac troponin T release.
  
  
  CONCLUSIONS
  Sevoflurane preconditioning preserves myocardial and renal function as assessed by biochemical markers in patients undergoing coronary artery bypass graft surgery under cardioplegic arrest. This study demonstrated for the first time translocation of protein kinase C isoforms delta and epsilon in human myocardium in response to sevoflurane.
authors.affiliation: Department of Anesthesiology, University Hospital Lausanne, Switzerland.
authors.forename: Karine
authors.initials: K
authors.lastname: Julier
authors.forename: Rafaela
authors.initials: R
authors.lastname: da Silva
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia
authors.forename: Lukas
authors.initials: L
authors.lastname: Bestmann
authors.forename: Philippe
authors.initials: P
authors.lastname: Frascarolo
authors.forename: Andreas
authors.initials: A
authors.lastname: Zollinger
authors.forename: Pierre-Guy
authors.initials: PG
authors.lastname: Chassot
authors.forename: Edith R
authors.initials: ER
authors.lastname: Schmid
authors.forename: Marko I
authors.initials: MI
authors.lastname: Turina
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: Thomas
authors.initials: T
authors.lastname: Pasch
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Michael
authors.initials: M
authors.lastname: Zaugg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D015415:Biomarkers; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D015716:Electrocardiography, Ambulatory; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000517:prevention & control*; D006801:Humans; D007150:Immunohistochemistry; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D007674:Kidney Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000517:prevention & control*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D011493:Protein Kinase C / Q000097:blood; D000077149:Sevoflurane; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D011493:Protein Kinase C; D003402:Creatine Kinase