Sevoflurane and Isoflurane-Pharmacokinetics, Hemodynamic Stability, and Cardioprotective Effects During Cardiopulmonary Bypass.
OBJECTIVE
This study aimed to evaluate the pharmacokinetic profiles of sevoflurane and isoflurane during use of minimized extracorporeal circulation to perform coronary artery bypass graft surgery. Furthermore, cardiovascular stability during bypass and the postoperative release of troponins were evaluated.


METHODS
Prospective, randomized study.


METHODS
University hospital.


METHODS
The study comprised 31 adult patients undergoing coronary artery bypass grafting.


METHODS
The pharmacokinetic measurements of the concentration of the volatile anesthetics in the arterial and venous blood, air inlet, air outlet, and gas exhaust of the extracorporeal circulation were recorded. Secondary end-points were cardiovascular stability during bypass, amount of postoperative release of troponin, time to extubation, time to discharge from the intensive care unit and the hospital, and 30-day mortality.


RESULTS
Thirty patients completed the protocol. The pharmacokinetics of isoflurane and sevoflurane were almost identical, with a rapid wash-in (time to reach 50% of arterial steady state) concentration of 0.87±0.97 minutes and 1.14±0.35 minutes for isoflurane and sevoflurane, respectively, and a biphasic venous elimination with a terminal half-life of approximately 10 minutes for both compounds. There was a correlation between the gas inlet and the gas exhaust of the extracorporeal circulation. No difference in cardiovascular stability was found. High-sensitivity troponin concentrations on the first postoperative morning were 0.355±0.312 µg/mL and 0.225±0.111 µg/mL in the isoflurane and sevoflurane groups, respectively (p = 0.147).


CONCLUSIONS
The study found similar pharmacokinetics regarding wash-in and wash-out for sevoflurane and isoflurane. In addition, no difference in cardiovascular stability was found. The markers of cardiac damage were not different between the two anesthetics. Based on these data, sevoflurane and isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
David
D
Freiermuth
Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA.
Berend
B
Mets
Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Daniel
D
Bolliger
Division of Cardiac Surgery, Department of Surgery, University Hospital Basel, Basel, Switzerland.
Oliver
O
Reuthebuch
Division of Cardiac Surgery, Department of Surgery, University Hospital Basel, Basel, Switzerland.
Thomas
T
Doebele
Institute of Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany.
Markus
M
Scholz
Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Michael
M
Gregor
Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.
Matthias
M
Haschke
Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland; Institute of Anesthesia and Intensive Care Medicine, Klinik Hirslanden Zürich, Zürich, Switzerland.
Manfred Daniel
MD
Seeberger
Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. Electronic address: Jens.fassl@usb.ch.
Jens
J
Fassl
D000368:Aged; D018685:Anesthetics, Inhalation / Q000097:blood* / Q000494:pharmacology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002316:Cardiotonic Agents / Q000097:blood* / Q000494:pharmacology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006207:Half-Life; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000097:blood* / Q000494:pharmacology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008738:Methyl Ethers / Q000097:blood* / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane; D020107:Troponin T / Q000097:blood
D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D007530:Isoflurane
cardioprotective effects; hemodynamic effects; isoflurane; minimized extracorporeal cardiopulmonary bypass; pharmacokinetics; sevoflurane; volatile anesthetics