title: Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial.
abstract: BACKGROUND
  Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery.
  
  
  METHODS
  
  
  
  METHODS
  Prospective, randomised open-lable study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume.
  
  
  RESULTS
  No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: -14.3 and -19.8 [g m m⁻² beat⁻¹]), respectively (P = 0.029). Oxygen uptake index (VO₂I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration.
  
  
  CONCLUSIONS
  This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism.
  
  
  BACKGROUND
  NCT00528515 (http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1).
authors.forename: Paweł
authors.initials: P
authors.lastname: Mroziński
authors.affiliation: rlango@gumed.edu.pl.
authors.forename: Romuald
authors.initials: R
authors.lastname: Lango
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Biedrzycka
authors.forename: Maciej Michał
authors.initials: MM
authors.lastname: Kowalik
authors.forename: Rafał
authors.initials: R
authors.lastname: Pawlaczyk
authors.forename: Jan
authors.initials: J
authors.lastname: Rogowski
mesh_terms: D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D015415:Biomarkers; D047549:Coronary Artery Bypass, Off-Pump; D052279:Creatine Kinase, MB Form / Q000097:blood; D000077335:Desflurane; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D010101:Oxygen Consumption / Q000187:drug effects; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D019210:Troponin I; D000077335:Desflurane; D007530:Isoflurane; D052279:Creatine Kinase, MB Form; D015742:Propofol