title: Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin.
abstract: BACKGROUND
  Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery.
  
  
  METHODS
  We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628).
  
  
  RESULTS
  We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)].
  
  
  CONCLUSIONS
  Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Guarnieri
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.affiliation: 2 Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Simone
authors.affiliation: 2 Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alcira
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cassarà
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.|3 Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: 1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.|3 Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D019210:Troponin I
keywords: anaesthesia; cardiac surgery; cardiopulmonary bypass; troponin; volatile anaesthetics