title: Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial.
abstract: OBJECTIVE
  Several studies have suggested that the cardioprotective effects of halogenated anesthetics in cardiac surgery result in reduced cardiac biomarker release compared with total intravenous anesthesia (TIVA). These findings came from relatively small randomized clinical trials and meta-analyses. The authors of this study hypothesized that the beneficial effects of volatile anesthetics translate into a reduced length of hospital stay after coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass.
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Two university hospitals.
  
  
  METHODS
  Adult patients undergoing elective CABG surgery with cardiopulmonary bypass.
  
  
  METHODS
  Patients were assigned randomly to 2 following groups: propofol-based TIVA group (n = 431) and sevoflurane group (n = 437).
  
  
  RESULTS
  The primary endpoint was hospital length of stay, and the secondary endpoint included postoperative troponin T and N-terminal pro-brain natriuretic peptide release and mortality. In the sevoflurane group, a reduced length of hospital stay was observed compared with the propofol-based TIVA group (10 [9-11] days v 14 [10-16], p<0.001) as were reductions in cardiac troponin T release (0.18 ng/mL v 0.57 ng/mL at 24 hours, p<0.001), in N-terminal pro-brain natriuretic peptide release (633 pg/mL v 878 pg/mL at 24 hours, p<0.001; 482 pg/mL v 1,036 pg/mL at 48 hours, p<0.001), and in mortality at 1-year follow up (17.8% v 24.8%, p = 0.03).
  
  
  CONCLUSIONS
  Anesthesia with sevoflurane reduced cardiac biomarker release and length of hospital stay after CABG with cardiopulmonary bypass surgery compared with propofol-based TIVA with a possible reduction in 1-year mortality.
authors.affiliation: Anesthesiology and Intensive Care Department, Moscow Regional Research and Clinical Institute, Moscow, Russia.
authors.forename: Valery V
authors.initials: VV
authors.lastname: Likhvantsev
authors.affiliation: Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Cardiology Intensive Care Unit, V.A. Negovsky Research Institute of Reanimatology, Moscow, Russia.
authors.forename: Dmitry I
authors.initials: DI
authors.lastname: Levikov
authors.affiliation: Anesthesiology and Intensive Care Department, Moscow Regional Research and Clinical Institute, Moscow, Russia.
authors.forename: Oleg A
authors.initials: OA
authors.lastname: Grebenchikov
authors.affiliation: Anesthesiology and Intensive Care Department, Moscow Regional Research and Clinical Institute, Moscow, Russia.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Skripkin
authors.affiliation: Anesthesiology and Intensive Care Department, V.A. Negovsky Research Institute of Reanimatology, Moscow, Russia.
authors.forename: Rostislav A
authors.initials: RA
authors.lastname: Cherpakov
mesh_terms: D018685:Anesthetics, Inhalation / Q000097:blood / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008738:Methyl Ethers / Q000097:blood / Q000494:pharmacology*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D010446:Peptide Fragments / Q000097:blood / Q000187:drug effects; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D015742:Propofol / Q000097:blood / Q000494:pharmacology*; D000077149:Sevoflurane; D020107:Troponin T / Q000097:blood / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D008738:Methyl Ethers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077149:Sevoflurane; D015742:Propofol
keywords: anesthesia; cardiac surgery; inhalation anesthesia; intravenous anesthesia; mortality; sevoflurane; survival analysis