Cardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study.
BACKGROUND
This study was undertaken to compare the in vivo effects of isoflurane, sevoflurane, and propofol anesthesia on ischemia- and reperfusion-mediated free-radical injury and oxidative stress during coronary artery bypass graft surgery. We also compared the effects of these anesthetic agents on levels of end products of lipid peroxidation and nitric oxide (NO) in human right atrial tissue and blood.


METHODS
Sixty patients scheduled to undergo elective coronary surgery with cardiopulmonary bypass (CPB) were enrolled. Patients were randomly allocated to receive 1 of 3 different anesthetic protocols: propofol (group A), isoflurane (group B), or sevoflurane (group C). We recorded global hemodynamic data (mean arterial pressure, mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac output, cardiac index, and systemic vascular resistance index) just before the start of surgery, before the start of CPB, 15 minutes after the end of CPB, at the end of the operation, 6 hours after installation in the intensive care unit, and 12 and 24 hours later. Samples of the right atrial appendage were harvested before and after exposure of the heart to blood cardioplegia and short-term reperfusion under conditions of CPB. Biochemical and oxidative stress parameters were analyzed in both blood and tissue.


RESULTS
Hemodynamic parameters were kept stable throughout in all groups. Troponin I increased transiently with all used anesthetic regimens, but this increase was significantly lower in groups B and C. After clamp removal, lipid peroxidation in patients who received propofol (group A) was less than in patients who received isoflurane (group B) or sevoflurane (group C) (P= .001, P= .005, respectively). Although the 3 groups showed no statistically significant differences in tissue levels of thiobarbituric acid-reactive substances and superoxide dismutase, propofol significantly lowered NO production in atrial tissue after clamp removal and induced less NO production than sevoflurane (P< .05).


CONCLUSIONS
Inhalation anesthetics such as isoflurane and sevoflurane preserved cardiac function in coronary surgery patients after CPB with less evidence for myocardial damage than propofol. Furthermore, propofol induced lower blood levels of lipid peroxidation than isoflurane and sevoflurane. Propofol also increased glutathione peroxidase activity but induced less NO production compared to sevoflurane. These findings also support the cardioprotective properties that are demonstrated by hemodynamic parameters.
Yildirim
Vedat
V
Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey. drvyildirim@yahoo.com
Doganci
Suat
S
Aydin
Ahmet
A
Bolcal
Cengiz
C
Demirkilic
Ufuk
U
Cosar
Ahmet
A
D000280:Administration, Inhalation; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000209:etiology* / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D000077149:Sevoflurane; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000517:prevention & control*
D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D015742:Propofol