title: Sevoflurane vs. propofol in patients with coronary disease undergoing mitral surgery: a randomised study.
abstract: BACKGROUND
  Myocardial ischemic damage is reduced by volatile anaesthetics in patients undergoing low-risk coronary artery bypass graft surgery; few and discordant results exist in other settings. We therefore performed a randomised controlled trial (sevoflurane vs. propofol) to compare cardiac troponin release in patients with coronary disease undergoing mitral surgery.
  
  
  METHODS
  Patients with coronary artery disease undergoing mitral surgery were randomly allocated to receive either sevoflurane (50 patients) or propofol (50 patients) as main hypnotic. The primary endpoint of the study was peak post-operative cardiac troponin release defined as the maximum value among the post-operative values measured at intensive care unit arrival, 4 h later, on the first and second post-operative day.
  
  
  RESULTS
  There was no significant difference in post-operative peak troponin release, the median (25th-75th percentiles) values being 14.9 (10.1-22.1) ng/ml and 14.5 (8.8-17.6) ng/ml in the sevoflurane and propofol groups, respectively (P = 0.4). Fentanyl administration was different between the two groups: 1347 ± 447 μg in patients receiving sevoflurane and 1670 ± 469 μg in those receiving propofol, P = 0.002. The 1-year follow-up identified two patients who died in the propofol group (one myocardial infarction and one low cardiac output syndrome) and one in the sevoflurane group (myocardial infarction).
  
  
  CONCLUSIONS
  In this study, patients with coronary artery disease undergoing mitral surgery did not benefit from the cardioprotective properties of halogenated anaesthetics. Sevoflurane anaesthesia was not associated to lower cardiac troponin release when compared with propofol anaesthesia.
authors: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
authors: E
authors: E
authors: Bignami
authors: G
authors: G
authors: Landoni
authors: C
authors: C
authors: Gerli
authors: V
authors: V
authors: Testa
authors: A
authors: A
authors: Mizzi
authors: G
authors: G
authors: Fano
authors: M
authors: M
authors: Nuzzi
authors: A
authors: A
authors: Franco
authors: A
authors: A
authors: Zangrillo
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000494:pharmacology*; D003324:Coronary Artery Disease / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D016037:Single-Blind Method; D014336:Troponin / Q000097:blood
chemical_list: D000777:Anesthetics; D008738:Methyl Ethers; D014336:Troponin; D000077149:Sevoflurane; D015742:Propofol