title: Volatile agents for cardiac protection in noncardiac surgery: a randomized controlled study.
abstract: OBJECTIVE
  Volatile anesthetics reduce the risk of myocardial infarction and mortality in coronary artery surgery. Recently, the American College of Cardiology/American Heart Association Guidelines suggested the use of volatile anesthetic agents for the maintenance of general anesthesia during noncardiac surgery in patients at risk for perioperative myocardial ischemia, but no randomized experience to document the cardioprotective effects of these agents exists in this setting. Therefore, the authors performed a prospective, randomized, controlled trial to compare the effects of sevoflurane versus total intravenous anesthesia, in terms of postoperative cardiac troponin I release in patients undergoing noncardiac surgery.
  
  
  METHODS
  A randomized, controlled trial.
  
  
  METHODS
  A teaching hospital.
  
  
  METHODS
  Eighty-eight consecutive patients undergoing noncardiac surgery.
  
  
  METHODS
  Patients were allocated randomly to receive either volatile anesthetic (44 patients) as the main anesthetic agent or total intravenous anesthesia (TIVA) (44 patients).
  
  
  METHODS
  Postoperative cardiac troponin I release was measured as a marker of myocardial necrosis. Patients with detectable postoperative troponin I in the sevoflurane group (12/44, 27.3%) were similar to those in the propofol group (9/44, 20.5%; p = 0.6). There was no significant reduction of postoperative median peak cTnI release (0.16 ± 0.71 ng/mL in the sevoflurane group compared with the TIVA group, 0.03 ± 0.08 ng/mL; p = 0.4). Three patients died at the 1-year follow-up for noncardiac causes (2 in the TIVA group).
  
  
  CONCLUSIONS
  In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery.
authors.affiliation: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Valentina
authors.initials: V
authors.lastname: Testa
authors.forename: Valeria
authors.initials: V
authors.lastname: Aldrovandi
authors.forename: Antonio
authors.initials: A
authors.lastname: Tuoro
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Casiraghi
authors.forename: Francesca
authors.initials: F
authors.lastname: Cavenago
authors.forename: Melissa
authors.initials: M
authors.lastname: Messina
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous; D002316:Cardiotonic Agents; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009336:Necrosis; D015742:Propofol; D011446:Prospective Studies; D000077149:Sevoflurane; D013514:Surgical Procedures, Operative / Q000379:methods*; D019210:Troponin I / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D015742:Propofol