title: Cardiac outcome after sevoflurane versus propofol sedation following coronary bypass surgery: a pilot study.
abstract: BACKGROUND
  Studies of volatile anesthetic administration during coronary artery bypass grafting (CABG) report reduced serum levels of post-operative cardiac troponin-T (cTnT). Our primary objective was to evaluate whether short-term sedation with sevoflurane in the intensive care unit (ICU)--after CABG--could affect the release of cTnT, compared with propofol sedation.
  
  
  METHODS
  Following isolated CABG with cardiopulmonary bypass, 100 patients were randomized to either sevoflurane via the Anesthetic Conserving Device (AnaConDa(®)) or propofol for ICU sedation. Study drugs were administered for 2 h during mechanical ventilation and thereafter until extubation criteria were met. The primary endpoint was cTnT 12 h post-operatively. Crude cTnT data were not normally distributed and therefore compared with the Mann-Whitney U-test. Because of the skewed pre-operative and post-operative cTnT data, we performed a post hoc analysis of the change in cTnT between pre-operative values and 12 h post-operatively.
  
  
  RESULTS
  There was no statistically significant difference between groups in the primary endpoint cTnT values at 12 h post-operatively, cardiac events or the need for hemodynamic support. In the post hoc analysis, the cTnT increase from pre-operative values to 12 h post-operatively was less pronounced in the sevoflurane group (P=0.008).
  
  
  CONCLUSIONS
  Post-operative short-term sevoflurane sedation following CABG, in comparison with propofol, did not affect the cTnT values at 12 h post-operatively and clinical outcome was equal between groups. The result from the post hoc analysis, with less cTnT change over time, is nevertheless hypothesis-generating and warrants a larger study.
authors.affiliation: Institution of Molecular Medicine and Surgery, Section of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Stockholm, Sweden. jan.hellstrom@karolinska.se
authors.forename: J
authors.initials: J
authors.lastname: Hellström
authors.forename: A
authors.initials: A
authors.lastname: Öwall
authors.forename: J
authors.initials: J
authors.lastname: Bergström
authors.forename: P V
authors.initials: PV
authors.lastname: Sackey
mesh_terms: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D001831:Body Temperature / Q000187:drug effects; D016292:Procedural Sedation / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003422:Critical Care; D004311:Double-Blind Method; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D009206:Myocardium / Q000378:metabolism; D010100:Oxygen / Q000097:blood; D019990:Perioperative Care; D010865:Pilot Projects; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D015742:Propofol; D000077149:Sevoflurane; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D010100:Oxygen; D015742:Propofol