title: Protective Effect of Low-dose Sevoflurane Inhalation and Propofol Anesthesia on the Myocardium after Carotid Endarterectomy: A Randomized Controlled Trial.
abstract: BACKGROUND
  Myocardial infarction is an important cause of mortality after carotid endarterectomy (CEA). Sevoflurane provides myocardial protection to patients undergoing coronary surgery, but whether it also reduces the incidence of myocardial injury in CEA patients is unclear. In this study, we evaluated the cardioprotective effect of low-dose sevoflurane with propofol in patients undergoing CEA.
  
  
  METHODS
  This was a single-center, prospective, randomized study conducted between November 2011 and December 2013. The study population of 122 patients who underwent CEA were randomly assigned to two groups. Group A (n = 62) received propofol for anesthetic maintenance, and Group B (n = 60) additionally received 0.8% end-tidal sevoflurane. The bispectral index was kept at 40-60. Myocardial injury, defined as cardiac troponin I (cTnI) levels >0.04 ng/ml, was the primary end-point. Levels of cTnI were measured before anesthesia, and at 4, 24, and 72 h after surgery. Perioperative hemodynamic parameters and adverse cardiovascular events after surgery were also recorded.
  
  
  RESULTS
  Myocardial injury was detected in 18 patients in Group A and 7 in Group B. The difference was statistically significant (29.0% vs. 11.7%, P = 0.018). The hemodynamic parameters were comparable between the groups, as were adverse cardiovascular events (P = 0.619).
  
  
  CONCLUSIONS
  Low-dose sevoflurane inhalation along with propofol reduces the incidence of myocardial injury in symptomatic patients after CEA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Tian-Long
authors.initials: TL
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Feng
authors.forename: Bing
authors.initials: B
authors.lastname: Cai
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use*; D000077149:Sevoflurane; D019210:Troponin I / Q000378:metabolism
chemical_list: D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D015742:Propofol