title: Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery.
abstract: OBJECTIVE
  The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery.
  
  
  METHODS
  After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2% . Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test.
  
  
  RESULTS
  Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10th minute and 20th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group.
  
  
  CONCLUSIONS
  Sevoflurane provides a better myocardial protection than isoflurane, as may be inferred by the lower levels of the myocardial injury markers troponin-T and CK-MB observed with sevoflurane.
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Eskişehir Osmangazi University, Turkey. drdcetinkaya@mynet.com
authors.forename: Dilek
authors.initials: D
authors.lastname: Ceyhan
authors.forename: Belkıs
authors.initials: B
authors.lastname: Tanrıverdi
authors.forename: Ayten
authors.initials: A
authors.lastname: Bilir
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation; D001026:Coronary Artery Bypass / Q000379:methods*; D003402:Creatine Kinase / Q000032:analysis; D052279:Creatine Kinase, MB Form / Q000032:analysis; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009206:Myocardium / Q000201:enzymology; D000077149:Sevoflurane; D020107:Troponin T / Q000032:analysis / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D007530:Isoflurane; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form