title: Myocardial damage prevented by volatile anesthetics: a multicenter randomized controlled study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effects of volatile anesthesia versus total intravenous anesthesia on cardiac troponin release in off-pump coronary artery bypass grafting (OPCAB).
  
  
  METHODS
  The authors performed a multicenter randomized controlled study to compare cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for cardiac surgery on the beating heart, which is an excellent model of human myocardial ischemia.
  
  
  METHODS
  Three university hospitals.
  
  
  METHODS
  The authors randomly assigned 57 patients to desflurane (volatile anesthetic) and 55 patients to propofol (intravenous anesthetic) in addition to an opiate-based anesthesia for OPCAB.
  
  
  METHODS
  The 2 groups of patients received either desflurane (volatile anesthetic) or propofol in addition to an opiate-based anesthesia for OPCAB. Peak postoperative troponin I release was measured as a marker of myocardial necrosis. Prolonged hospitalization was considered as a secondary outcome.
  
  
  RESULTS
  Patient mean age was 69 years, and 82% were men. There was a significant (p < 0.001) reduction in postoperative median (25th-75th percentiles) peak of troponin I in patients receiving volatile anesthetics, 1.2 (0.9-1.9) ng/dL, compared with patients receiving total intravenous anesthesia, 2.7 (2.1-4.0) ng/dL. This myocardial protection resulted in a reduced (p = 0.04) number (percentage) of patients requiring postoperative inotropes, 20 (35%) versus 31 (56%), and a reduced number (percentage) of patients submitted to prolonged hospitalization (> or =7 days), 7 (12%) versus 20 (36%) in the 2 groups (p = 0.005). One patient receiving total intravenous anesthesia died within 30 days of surgery.
  
  
  CONCLUSIONS
  Myocardial damage measured by cardiac troponin release could be reduced by volatile anesthetics during OPCAB. Because patients underwent cardiac surgery on the beating heart, these results could have implications for cardiac patients undergoing noncardiac surgery.
authors.affiliation: Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Azienda Ospedaliera Universitaria Pisana, Cisanello Hospital, Pisa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Luigi
authors.initials: L
authors.lastname: Tritapepe
authors.forename: Francesca
authors.initials: F
authors.lastname: Pompei
authors.forename: Albino
authors.initials: A
authors.lastname: Leoni
authors.forename: Giacomo
authors.initials: G
authors.lastname: Aletti
authors.forename: Anna Mara
authors.initials: AM
authors.lastname: Scandroglio
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.forename: Monica
authors.initials: M
authors.lastname: De Luca
authors.forename: Chiara
authors.initials: C
authors.lastname: Marchetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous; D047549:Coronary Artery Bypass, Off-Pump; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism; D015742:Propofol; D019210:Troponin I / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D019210:Troponin I; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol