Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: a pilot study.
BACKGROUND
Volatile anesthetics provide myocardial protection during cardiac surgery. Sevoflurane and desflurane are both efficient agents that allow immediate extubation after off-pump coronary artery bypass grafting (OPCABG). This study compared the incidence of arrhythmias after OPCABG with the two agents.


METHODS
Forty patients undergoing OPCABG with immediate extubation and perioperative high thoracic analgesia were included in this controlled, double-blind study; anesthesia was either provided using 1 MAC of sevoflurane (SEVO-group) or desflurane (DES-group). Monitoring of perioperative arrhythmias was provided by continuous monitoring of the EKG up to 72 hours after surgery, and routine EKG monitoring once every day, until time of discharge. Patient data, perioperative arrhythmias, and myocardial protection (troponin I, CK, CK-MB-ratio, and transesophageal echocardiography examinations) were compared using t-test, Fisher's exact test or two-way analysis of variance for repeated measurements; P < 0.05.


RESULTS
Patient data and surgery-related data were similar between the two groups; all the patients were successfully extubated immediately after surgery, with similar emergence times. Supraventricular tachycardia occurred only in the DES-group (5 of 20 patients), atrial fibrillation was significantly more frequent in the DES group versus SEVO-group, at five out of 20 versus one out of 20 patients, respectively. Myocardial protection was equally achieved in both groups.


CONCLUSIONS
Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery.
Hemmerling
Thomas M
TM
Department of Anesthesiology, McGill University, Montreal, Canada. thomashemmerling@hotmail.com
Minardi
Carmelo
C
Zaouter
Cedrick
C
Noiseux
Nicolas
N
Prieto
Ignatio
I
D000368:Aged; D000769:Anesthesia, Inhalation / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001281:Atrial Fibrillation / Q000517:prevention & control; D047549:Coronary Artery Bypass, Off-Pump; D052279:Creatine Kinase, MB Form / Q000097:blood; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010865:Pilot Projects; D000077149:Sevoflurane; D013617:Tachycardia, Supraventricular / Q000139:chemically induced / Q000517:prevention & control; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D052279:Creatine Kinase, MB Form