Myocardial protection by isoflurane vs. sevoflurane in ultra-fast-track anaesthesia for off-pump aortocoronary bypass grafting.
OBJECTIVE
Volatile anaesthetics have gained more popularity recently due to the potential for cardiac protection. Ultra-fast-track anaesthesia implies the immediate extubation after cardiac surgery. The purpose of this prospective randomized double-blind controlled study is to compare the cardioprotective effects of sevoflurane and isoflurane in off-pump cardiac bypass surgery.


METHODS
Forty patients undergoing elective off-pump cardiac bypass surgery with high thoracic epidural analgesia and immediate extubation at the end of surgery were randomized into two groups. During surgery, anaesthesia was provided with either 1 minimum alvelolar anaesthetic concentration of sevoflurane or 1 minimum alvelolar anaesthetic concentration of isoflurane. Troponin-T, creatine kinase-MB, left ventricular wall motion anomalies, time to extubation, respiratory functions and haemodynamic parameters were compared between the two groups by analysis of variance.


RESULTS
All patients were successfully extubated in the operating theatre with minimal postoperative pain. Serial creatine kinase-MB and troponin-T concentrations were not significantly different between the two volatile agents. Haemodynamic stability throughout surgery and contractility was not different between groups. However, extubation time was significantly shorter with sevoflurane (10 +/- 5 min) compared to isoflurane (18 +/- 4 min).


CONCLUSIONS
This study indicates that during off-pump cardiac bypass surgery, sevoflurane and isoflurane provide the same ischaemic cardioprotective effects. There is no difference for heart contractility and haemodynamic values during and after off-pump cardiac bypass surgery between the two agents. Sevoflurane allows a more rapid recovery from anaesthesia, but this does not translate into better pulmonary function or haemodynamics. Both agents are similar in ultra-fast-track off-pump cardiac bypass surgery.
Hemmerling
T
T
McGill University Health Center, Hôtel-Dieu Hospital, Cardiac Surgery Department, Montréal, Québec, Canada.
Olivier
J-F
JF
Le
N
N
Prieto
I
I
Bracco
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000627:therapeutic use*; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D018685:Anesthetics, Inhalation; D015415:Biomarkers; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D007530:Isoflurane; D003402:Creatine Kinase