A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery.
A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.
De Hert
S
S
Division of Cardiothoracic and Vascular Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands. s.g.dehert@amc.uva.nl
Vlasselaers
D
D
Barbé
R
R
Ory
J-P
JP
Dekegel
D
D
Donnadonni
R
R
Demeere
J-L
JL
Mulier
J
J
Wouters
P
P
D000368:Aged; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D000077335:Desflurane; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods; D007530:Isoflurane / Q000031:analogs & derivatives / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D000077149:Sevoflurane; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane