title: Myocardial oxidative stress protection by sevoflurane vs. propofol:  a randomised controlled study in patients undergoing off-pump coronary artery bypass graft surgery.
abstract: BACKGROUND
  Myocardial oxidative stress plays an essential role in the pathogenesis of ischaemia-reperfusion injury associated with coronary artery bypass grafting (CABG). Both propofol and volatile anaesthetics have been shown to reduce reactive oxygen species in experimental and clinical studies.
  
  
  OBJECTIVE
  To compare the influence of sevoflurane and propofol on myocardial oxidative stress markers (F2-isoprostanes and nitrates/nitrites) in coronary sinus blood samples from patients undergoing off-pump CABG.
  
  
  METHODS
  Randomised controlled clinical study of patients scheduled for off-pump CABG in a tertiary academic university hospital from June 2007 to August 2009. Forty patients consented to enrolment and were assigned to receive either propofol or sevoflurane.
  
  
  METHODS
  Upon completion of the proximal anastomosis, a retroplegia cannula was inserted in the coronary sinus to obtain blood samples, according to the study protocol.
  
  
  METHODS
  Markers of lipoperoxidation (F2-isoprostanes) and nitrosative stress (nitrates/nitrites) were measured in coronary sinus blood samples at three time points: after the end of the proximal anastomosis (T1), after completion of all grafts (T2) and 15 min after revascularisation (T3).
  
  
  RESULTS
  Of the 40 recruited patients, 38 fully completed the study. In the sevoflurane group (n = 20), concentrations of oxidative stress markers in the coronary sinus remained almost constant and were significantly lower than those in the propofol group (n = 18) at all time points. F2-isoprostanes concentrations were as follows at T1: sevoflurane group 37.2 ± 27.5 pg ml vs. propofol group 170.7 ± 30.9 pg ml [95% confidence interval (CI) 112.16-155.08, P < 0.0001); at T2: sevoflurane group 31.94 ± 24.6 pg ml vs. propofol group 171.6 ± 29.7 pg ml (95% CI 119.78-159.63, P < 0.0001); and at T3: sevoflurane group 23.8 ± 13.0 pg ml vs. propofol group 43.6 ± 31 pg ml (95% CI 2.87-36.63, P = 0.023).
  
  
  CONCLUSIONS
  In patients undergoing off-pump CABG, sevoflurane showed better antioxidative properties than propofol.
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Clinico Universitario, Valencia, Spain. ballester.mayte@gmail.com
authors.forename: Mayte
authors.initials: M
authors.lastname: Ballester
authors.forename: Julio
authors.initials: J
authors.lastname: Llorens
authors.forename: Jose
authors.initials: J
authors.lastname: Garcia-de-la-Asuncion
authors.forename: Jaime
authors.initials: J
authors.lastname: Perez-Griera
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tebar
authors.forename: Juan
authors.initials: J
authors.lastname: Martinez-Leon
authors.forename: Javier
authors.initials: J
authors.lastname: Belda
authors.forename: Marina
authors.initials: M
authors.lastname: Juez
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D005260:Female; D006801:Humans; D015227:Lipid Peroxidation / Q000187:drug effects / Q000502:physiology; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D018384:Oxidative Stress / Q000187:drug effects / Q000502:physiology*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane; D016037:Single-Blind Method
chemical_list: D000975:Antioxidants; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol