Isoflurane, 0.5 minimum alveolar concentration administered through the precardiopulmonary bypass period, reduces postoperative dobutamine requirements of cardiac surgery patients: a randomized study.
OBJECTIVE
Cardioprotective properties have been shown with halogenated volatile agents. It was hypothesized that low-dose isoflurane administered before aortic cross-clamping may reduce the amount of dobutamine required to improve impaired postoperative cardiac function after various types of cardiac surgery.


METHODS
A prospective, randomized trial.


METHODS
An anesthesia and intensive care unit, university hospital.


METHODS
Two hundred eighty cardiac surgery patients.


METHODS
All patients allocated to either isoflurane treatment (T) or no treatment (control group [C]) received total intravenous anesthesia. In the treatment group, isoflurane was administered at a 0.5 minimum alveolar concentration (MAC) from tracheal intubation to initiation of cardiopulmonary bypass (CPB). During weaning from CPB, dobutamine was introduced by using a hemodynamically driven decision tree.


RESULTS
The number of patients receiving dobutamine was comparable (66 v 78, p = 0.07, in T and C groups, respectively). The total amount of postoperative dobutamine indexed to patient weight, considered as the primary endpoint, was reduced in the isoflurane-treated group (4.2 +/- 8 v 7.2 +/- 15, p < 0.02, in T and C, respectively). Isoflurane was identified as an independent variable significantly (odds ratio [confidence interval]) influencing the total amount of postoperative dobutamine (0.53 [0.31-0.92], p < 0.02). Postoperative troponin I release at 20 hours was not affected by isoflurane treatment.


CONCLUSIONS
This study revealed that exposure to 0.5 MAC isoflurane before CPB reduced the total amount of dobutamine required to normalize postoperative cardiac dysfunction in various types of cardiac surgical patients.
Ndoko
Serge K
SK
Department of Anesthesiology and Surgical Intensive Care, Paris XII, University Hospital Henri Mondor, Créteil, France. serge.ndoko@jvr.aphp.fr
Tual
Loïc
L
Ait Mamar
Bouziane
B
Sauvat
Stéphane
S
Jabre
Patricia
P
Zakhouri
Mohamed
M
Rosanval
Odile
O
Abdi
Moustapha
M
Kirsch
Matthias
M
Pouzet
Bruno
B
Loisance
Daniel
D
Dhonneur
Gilles
G
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000368:Aged; D000465:Algorithms; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004280:Dobutamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
D000318:Adrenergic beta-Agonists; D018685:Anesthetics, Inhalation; D015415:Biomarkers; D019210:Troponin I; D004280:Dobutamine; D007530:Isoflurane