Impact of preconditioning protocol on anesthetic-induced cardioprotection in patients having coronary artery bypass surgery.
OBJECTIVE
Anesthetic preconditioning may contribute to the cardioprotective effects of sevoflurane in patients having coronary artery bypass surgery. We investigated whether 2 different sevoflurane administration protocols can induce preconditioning in patients having coronary artery bypass.


METHODS
Thirty patients were randomly allocated to 1 of 3 groups. All patients received a total intravenous anesthesia with sufentanil (0.3 microg(-1) x kg x h(-1)) and propofol as target controlled infusion (2.5 microg/mL). The control group had no further intervention; 10 minutes prior to establishing the extracorporeal circulation, patients of the sevoflurane-I group received 1 minimum alveolar concentration of sevoflurane for 5 minutes. Patients of the sevoflurane-II group received (2 times) 5 minutes of sevoflurane, interspersed by 5-minute washout 10 minutes prior to extracorporeal circulation. Troponin I was measured as marker of cardiac cellular damage.


RESULTS
Peak levels of troponin I release were observed at 4 hours after cardiopulmonary bypass and were not affected by 1 cycle of sevoflurane administration (controls: 14 +/- 3 ng/mL vs sevoflurane-I group, 14 +/- 3 ng/mL). Two periods of sevoflurane preconditioning significantly reduced cellular damage compared with controls (peak troponin I level sevoflurane-II group, 7 +/- 2 ng/mL).


CONCLUSIONS
These data show that sevoflurane-induced preconditioning is reproducible in patients having coronary artery bypass but depends on the preconditioning protocol used.
Frässdorf
Jan
J
Department of Anesthesiology, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands.
Borowski
Andreas
A
Ebel
Dirk
D
Feindt
Peter
P
Hermes
Manuel
M
Meemann
Thomas
T
Weber
René
R
Müllenheim
Jost
J
Weber
Nina C
NC
Preckel
Benedikt
B
Schlack
Wolfgang
W
D000368:Aged; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D000077149:Sevoflurane; D016277:Ventricular Function, Left
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane