Cardiac protection by volatile anaesthetics: a multicentre randomized controlled study in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
OBJECTIVE
To evaluate the effects of total intravenous anaesthesia vs. volatile anaesthesia on cardiac troponin release in coronary artery bypass grafting with cardiopulmonary bypass, we performed a multicentre randomized controlled study to compare postoperative cardiac troponin release in patients receiving two different anaesthesia plans.


METHODS
We randomly assigned 75 patients to propofol (intravenous anaesthetic) and 75 patients to desflurane (volatile anaesthetic) in addition to an opiate-based anaesthesia for coronary artery bypass grafting. Peak postoperative troponin I release was measured as a marker of myocardial necrosis.


RESULTS
There was a significant (P < 0.001) difference in the postoperative median (25th-75th percentiles) peak of troponin I in patients receiving propofol 5,5 (2,3-9,5) ng dL(-1) when compared to patients receiving desflurane 2,5 (1,1-5,3) ng dL(-1). The median (interquartile) troponin I area under the curve analysis confirmed the results: 68 (30.5-104.8) vs. 36.3 (17.9-86.6) h ng dL(-1) (P = 0.002). Patients receiving volatile anaesthetics had reduced need for postoperative inotropic support (24/75, 32.0% vs. 31/75, 41.3%, P = 0.04), and tends toward a reduction in number of Q-wave myocardial infarction, time on mechanical ventilation, intensive care unit and overall hospital stay.


CONCLUSIONS
Myocardial damage measured by cardiac troponin release could be reduced by volatile anaesthetics in coronary artery bypass surgery.
Tritapepe
L
L
Università degli Studi La Sapienza di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy.
Landoni
G
G
Guarracino
F
F
Pompei
F
F
Crivellari
M
M
Maselli
D
D
De Luca
M
M
Fochi
O
O
D'Avolio
S
S
Bignami
E
E
Calabrò
M G
MG
Zangrillo
A
A
D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D000077335:Desflurane; D005260:Female; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology; D019210:Troponin I / Q000097:blood
D018685:Anesthetics, Inhalation; D019210:Troponin I; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol