Late pharmacologic conditioning with volatile anesthetics after cardiac surgery.
BACKGROUND
The aim of this randomized controlled trial was to investigate whether volatile anesthetics used for postoperative sedation have any beneficial effects on myocardial injury in cardiac surgery patients after on-pump valve replacement.


METHODS
Anesthesia was performed with propofol. After arrival in the intensive care unit (ICU), 117 patients were randomized to be sedated for at least 4 hours with either propofol or sevoflurane. Sevoflurane was administered by using the anesthetic-conserving device. Troponin T, creatine kinase, creatine kinase from heart muscle tissue, myoglobin, and oxygenation index were determined on arrival at the ICU, 4 hours after sedation, and in the morning of the first postoperative day (POD1). Primary end points were cardiac injury markers on POD1. As secondary end points oxygenation, postoperative pulmonary complications, and ICU and hospital stay were documented.


RESULTS
Fifty-six patients were analyzed in the propofol arm, and 46 patients in the sevoflurane arm. Treatment groups were comparable with regard to patient demographics and intraoperative characteristics. Concentration of troponin T as the most sensitive marker for myocardial injury at POD1 was significantly lower in the sevoflurane group compared with the propofol group (unadjusted difference, -0.4; 95% CI, -0.7 to -0.1; P < 0.01; adjusted difference, -0.2; 95% CI, -0.4 to -0.02; P = 0.03, respectively).


CONCLUSIONS
The data presented in this investigation indicate that late postconditioning with the volatile anesthetic sevoflurane might mediate cardiac protection, even with a late, brief, and low-dose application.


BACKGROUND
ClinicalTrials.gov: NCT00924222.
Marc P
MP
Steurer
Martina A
MA
Steurer
Werner
W
Baulig
Tobias
T
Piegeler
Martin
M
Schläpfer
Donat R
DR
Spahn
Volkmar
V
Falk
Pamela
P
Dreessen
Oliver M
OM
Theusinger
Edith R
ER
Schmid
David
D
Schwartz
Thomas A
TA
Neff
Beatrice
B
Beck-Schimmer
D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol