title: Comparison of the effects of sevoflurane, isoflurane, and desflurane on microcirculation in coronary artery bypass graft surgery.
abstract: OBJECTIVE
  This investigation was performed to compare the effects of inhalation agents on microcirculation in coronary artery bypass grafting (CABG) using orthogonal polarization spectral imaging.
  
  
  METHODS
  This prospective and randomized study was performed in patients scheduled for CABG surgery from March through September 2010.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Thirty patients undergoing elective CABG.
  
  
  METHODS
  Patients were assigned to sevoflurane, desflurane, or isoflurane.
  
  
  RESULTS
  Orthogonal polarization spectral imaging was used to evaluate the sublingual microcirculation. Hemodynamic variables (heart rate, mean arterial pressure, central venous pressure, cardiac output, and pulmonary capillary wedge pressure), laboratory parameters (hematocrit, lactate, and potassium), and microcirculatory variables (total vascular density [TVD] [mm/mm(2)], microvascular flow index [MFI] [arbitrary units], perfused vessel density [PVD] [mm/mm(2)], and proportion of perfused vessels [PPV] [percentage] were obtained before induction, after induction, during cardiopulmonary bypass, at the end of surgery, and 24 hours after surgery. The greatest alterations in microcirculation parameters were found during cardiopulmonary bypass. In the sevoflurane group, TVD (14.7%), PVD (22%), PPV (5.97%, p < 0.05), and MFI (7.69%, p > 0.05) were decreased. In the isoflurane group, TVD (14.7%) and PVD (20.3%) were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p < 0.05). In the desflurane group, there were no changes in TVD and PVD, but MFI (8.99%, p > 0.05) and PPV (1.48%, p < 0.05) were increased in the small vessels. These changes returned to their initial values 24 hours postoperatively.
  
  
  CONCLUSIONS
  Sevoflurane had a negative effect on the microcirculation. Isoflurane decreased vascular density and increased flow. Desflurane produced stable effects on the microcirculation. These inhalation agents induced transient alterations in microvascular perfusion.
authors.affiliation: Department of Anesthesia, Hacettepe University, Ankara, Turkey.
authors.forename: Nihal Gökbulut
authors.initials: NG
authors.lastname: Özarslan
authors.forename: Banu
authors.initials: B
authors.lastname: Ayhan
authors.forename: Meral
authors.initials: M
authors.lastname: Kanbak
authors.forename: Bilge
authors.initials: B
authors.lastname: Çelebioğlu
authors.forename: Metin
authors.initials: M
authors.lastname: Demircin
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Ülkü
authors.initials: Ü
authors.lastname: Aypar
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods*; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008833:Microcirculation / Q000187:drug effects* / Q000502:physiology; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane