title: Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients.
abstract: BACKGROUND
  The present study investigated the effects of propofol, desflurane, and sevoflurane on recovery of myocardial function in high-risk coronary surgery patients. High-risk patients were defined as those older than 70 yr with three-vessel disease and an ejection fraction less than 50% with impaired length-dependent regulation of myocardial function.
  
  
  METHODS
  Coronary surgery patients (n = 45) were randomly assigned to receive either target-controlled infusion of propofol or inhalational anesthesia with desflurane or sevoflurane. Cardiac function was assessed perioperatively and during 24 h postoperatively using a Swan-Ganz catheter. Perioperatively, a high-fidelity pressure catheter was positioned in the left and right atrium and ventricle. 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. Postoperative levels of cardiac troponin I were followed for 36 h.
  
  
  RESULTS
  After CPB, cardiac index and dP/dt(max) were significantly lower in patients under propofol anesthesia. Post-CPB, leg elevation resulted in a significantly greater decrease in dP/dt(max) in the propofol group, whereas the responses in the desflurane and sevoflurane groups were comparable with the responses before CPB. After CPB, load dependence of left ventricular pressure drop was significantly higher in the propofol group than in the desflurane and sevoflurane group. Troponin I levels were significantly higher in the propofol group.
  
  
  CONCLUSIONS
  Sevoflurane and desflurane but not propofol preserved left ventricular function after CPB in high-risk coronary surgery patients with less evidence of myocardial damage postoperatively.
authors.affiliation: Division of Cardiothoracic and Vascular Anesthesia, University Hospital Antwerp, Belgium. sdehert@uia.ac.be
authors.forename: Stefan G
authors.initials: SG
authors.lastname: De Hert
authors.forename: Stefanie
authors.initials: S
authors.lastname: Cromheecke
authors.forename: Pieter W
authors.initials: PW
authors.lastname: ten Broecke
authors.forename: Els
authors.initials: E
authors.lastname: Mertens
authors.forename: Ivo G
authors.initials: IG
authors.lastname: De Blier
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Stockman
authors.forename: Inez E
authors.initials: IE
authors.lastname: Rodrigus
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Van der Linden
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D001026:Coronary Artery Bypass; D000077335:Desflurane; D005260:Female; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers; D009200:Myocardial Contraction / Q000187:drug effects; D011184:Postoperative Period; D015742:Propofol; D000077149:Sevoflurane; D013318:Stroke Volume / Q000187:drug effects; D019210:Troponin I / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol