Sevoflurane provides earlier tracheal extubation and assessment of cognitive recovery than isoflurane in patients undergoing off-pump coronary artery bypass surgery.
OBJECTIVE
To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery.


METHODS
Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 microg/kg of fentanyl.


METHODS
Two university hospitals with active cardiac surgery programs.


METHODS
One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval.


METHODS
Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes.


RESULTS
Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 +/- 217 minutes and Iso, 257 +/- 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03).


CONCLUSIONS
Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.
Delphin
Ellise
E
Department of Anesthesiology, Division of Cardiothoracic Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA. delphiel@umdnj.edu
Jackson
Douglas
D
Gubenko
Yuriy
Y
Botea
Andrei
A
Esrig
Barry
B
Fritz
William
W
Mavridis
Savris
S
D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors; D019210:Troponin I / Q000097:blood / Q000187:drug effects
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D007530:Isoflurane