title: Isoflurane, 0.5 minimum alveolar concentration administered through the precardiopulmonary bypass period, reduces postoperative dobutamine requirements of cardiac surgery patients: a randomized study.
abstract: 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.
authors: Department of Anesthesiology and Surgical Intensive Care, Paris XII, University Hospital Henri Mondor, Créteil, France. serge.ndoko@jvr.aphp.fr
authors: Serge K
authors: SK
authors: Ndoko
authors: Loïc
authors: L
authors: Tual
authors: Bouziane
authors: B
authors: Ait Mamar
authors: Stéphane
authors: S
authors: Sauvat
authors: Patricia
authors: P
authors: Jabre
authors: Mohamed
authors: M
authors: Zakhouri
authors: Odile
authors: O
authors: Rosanval
authors: Moustapha
authors: M
authors: Abdi
authors: Matthias
authors: M
authors: Kirsch
authors: Bruno
authors: B
authors: Pouzet
authors: Daniel
authors: D
authors: Loisance
authors: Gilles
authors: G
authors: Dhonneur
mesh_terms: 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
chemical_list: D000318:Adrenergic beta-Agonists; D018685:Anesthetics, Inhalation; D015415:Biomarkers; D019210:Troponin I; D004280:Dobutamine; D007530:Isoflurane