title: Isoflurane compared with fentanyl-midazolam-based anesthesia in patients undergoing heart transplantation: A retrospective cohort study.
abstract: Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded. The perioperative variables and postoperative short-term outcomes were analyzed, including blood glucose levels, urine output, inotropic use, time to extubation, and length of stay in the intensive care units. After reviewing 112 heart transplantations, 18 recipients with fentanyl-midazolam-based anesthesia, and 29 receiving isoflurane anesthesia with minimal low-flow technique were analyzed. After cessation of cardiopulmonary bypass, recipients with isoflurane anesthesia had a significantly lower mean level and a less increase of blood glucose, as compared with those receiving fentanyl-based anesthesia. In addition, there was less use of dobutamine upon arriving the intensive care unit and a shorter time to extubation after isoflurane anesthesia. Compared with fentanyl-midazolam-based anesthesia, isoflurane minimal low-flow anesthesia maintained better perioperative homeostasis of blood glucose levels, less postoperative use of inotropics, and early extubation time among heart-transplant recipients without severe comorbidities.
authors: Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung Department of Anesthesiology, Tri-Service General Hospital Department of Anesthesiology, Taipei Veterans General Hospital Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei Division of Cardiovascular Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
authors: Che-Hao
authors: CH
authors: Hsu
authors: Yung-Chi
authors: YC
authors: Hsu
authors: Go-Shine
authors: GS
authors: Huang
authors: Chih-Cherng
authors: CC
authors: Lu
authors: Shung-Tai
authors: ST
authors: Ho
authors: Wen-Jinn
authors: WJ
authors: Liaw
authors: Yi-Ting
authors: YT
authors: Tsai
authors: Chih-Yuan
authors: CY
authors: Lin
authors: Chien-Sung
authors: CS
authors: Tsai
authors: Tso-Chou
authors: TC
authors: Lin
mesh_terms: D060666:Airway Extubation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001786:Blood Glucose / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D016027:Heart Transplantation; D006706:Homeostasis; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001786:Blood Glucose; D002316:Cardiotonic Agents; D007530:Isoflurane; D008874:Midazolam; D005283:Fentanyl