Early cardioprotective effect of sevoflurane on left ventricular performance during coronary artery bypass grafting on a beating heart: randomized controlled study.
OBJECTIVE
To evaluate the cardioprotective effect of sevoflurane on a beating heart in patients undergoing coronary artery bypass grafting with normal preoperative left ventricular function.


METHODS
The randomized controlled study included 32 patients induced with sevoflurane and then randomized to receive either 1 minimal alveolar concentration (MAC) end-tidal concentration of sevoflurane (n=16) or propofol (n=16) 2 to 3 mg kg(-1) hour(-1). The acceleration of the aortic blood flow, cardiac index, heart rate, mean arterial pressure, and central venous pressure were measured 5 minutes after anesthesia induction, at the beginning of ischemia, 15 minutes after ischemia, and 15 minutes after sternum closure.


RESULTS
There were no differences in heart rate, mean arterial pressure, and central venous pressure within each group and between groups during surgery. Acceleration increased in the sevoflurane group 15 minutes after ischemia (10.3+/-3.5 m/s(2); P=0.004) and 15 minutes after sternum closure (10.7+/-3.9 m/s(2); P<0.001). Acceleration in the propofol group decreased from the beginning of ischemia (P<0.001) and remained lower 15 minutes after sternum closure (P=0.001 and P=0.024, respectively). Acceleration was higher in the sevoflurane group at the beginning of ischemia and 15 minutes after sternum closure (P=0.017 and P=0.046, respectively). There were no significant differences in cardiac index values within the sevoflurane group. In the propofol group, significant decreases in cardiac index were seen at the beginning of ischemia (P<0.001). There were between-group differences in cardiac index values at the beginning of ischemia and 15 minutes after ischemia (P=0.002, and P=0.011, respectively).


CONCLUSIONS
Cardiac function was better preserved in the patients anesthetized with sevoflurane than in patients anesthetized with propofol.
Huseidzinović
Ino
I
Clinical Department of Anesthesiology, Reanimatology, and Intensive Care, Dubrava University Hospital, Zagreb, Croatia. inoh@kbd.hr
Barisin
Stjepan
S
Bradić
Nikola
N
Milanović
Rudolf
R
D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D020011:Protective Agents / Q000494:pharmacology*; D000077149:Sevoflurane; D016037:Single-Blind Method; D016277:Ventricular Function, Left / Q000187:drug effects*
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D020011:Protective Agents; D000077149:Sevoflurane