title: Cardioprotective effect of sevoflurane and propofol during anaesthesia and the postoperative period in coronary bypass graft surgery:  a double-blind randomised study.
abstract: BACKGROUND
  Volatile anaesthetics may have direct cardioprotective properties due to effects similar to ischaemic preconditioning and postconditioning. Clinical results in cardiac surgery patients are controversial and may be related to the timing of administration of anaesthetics intraoperatively.
  
  
  OBJECTIVE
  We hypothesised that the cardioprotective effect of sevoflurane in coronary bypass graft surgical patients would be greater if administration during anaesthesia continued in the ICU for at least 4 h postoperatively until weaning from mechanical ventilation.
  
  
  METHODS
  Double-blind, double-dummy, prospective, randomised and controlled clinical trial.
  
  
  METHODS
  In a single centre between June 2006 and June 2007.
  
  
  METHODS
  Seventy-five adult patients were assigned randomly to receive anaesthesia and postoperative sedation either with propofol (control, n = 37) or sevoflurane (n = 36).
  
  
  METHODS
  Myocardial biomarkers were measured before surgery, at the time of admission to the intensive care unit and at 6, 24, 48 and 72 h. The need for inotropic support, and lengths of stay in the intensive care unit and hospital were also recorded.
  
  
  METHODS
  Elevation of myocardial biomarkers was the primary endpoint. The secondary endpoints were haemodynamic events and lengths of stay in the intensive care unit and hospital.
  
  
  RESULTS
  Necrosis biomarkers increased significantly in the postoperative period in both groups with no significant differences at any time. Inotropic support was needed in 72.7 and 54.3% of patients in the propofol and sevoflurane groups, respectively (P = 0.086). There were no significant differences in haemodynamic variables, incidence of arrhythmias, myocardial ischaemia or and lengths of stay in the ICU and hospital between the two groups.
  
  
  CONCLUSIONS
  In patients undergoing coronary bypass graft surgery, continuous administration of sevoflurane as a sedative in the ICU for at least 4 h postoperatively did not yield significant improvements in the extent and time course of myocardial damage biomarkers compared to propofol.
authors.affiliation: Department of Anaesthesia and Critical Care, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Soro
authors.forename: Lucía
authors.initials: L
authors.lastname: Gallego
authors.forename: Vanessa
authors.initials: V
authors.lastname: Silva
authors.forename: María T
authors.initials: MT
authors.lastname: Ballester
authors.forename: Julio
authors.initials: J
authors.lastname: Lloréns
authors.forename: Ana
authors.initials: A
authors.lastname: Alvariño
authors.forename: María L
authors.initials: ML
authors.lastname: García-Perez
authors.forename: Ernesto
authors.initials: E
authors.lastname: Pastor
authors.forename: Gerardo
authors.initials: G
authors.lastname: Aguilar
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martí
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratala
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Belda
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass / Q000379:methods*; D003422:Critical Care / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D011184:Postoperative Period; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D015415:Biomarkers; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol