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Myocardial protection by isoflurane vs. sevoflurane in ultra-fast-track anaesthesia for off-pump aortocoronary bypass grafting

Published online by Cambridge University Press:  01 March 2008

T. Hemmerling ,
J.-F. Olivier ,
N. Le ,
I. Prieto  and
D. Bracco
T. Hemmerling
Affiliation:
McGill University Health Center, Montreal General Hospital, Department of Anesthesiology, Montréal, Québec, Canada Montreal University Health Center, Hôtel-Dieu Hospital, Cardiac Surgery Department, Montréal, Québec, Canada
J.-F. Olivier
Affiliation:
McGill University Health Center, Montreal General Hospital, Department of Anesthesiology, Montréal, Québec, Canada
N. Le
Affiliation:
McGill University Health Center, Montreal General Hospital, Department of Anesthesiology, Montréal, Québec, Canada
I. Prieto
Affiliation:
Montreal University Health Center, Hôtel-Dieu Hospital, Cardiac Surgery Department, Montréal, Québec, Canada
D. Bracco*
Affiliation:
McGill University Health Center, Montreal General Hospital, Department of Anesthesiology, Montréal, Québec, Canada
*
Correspondence to: David Bracco, Department of Anesthesiology, Montreal General Hospital, McGill University Health Center, Room D-10-145-3, 1650 Cedar Avenue, Montréal, Québec, Canada H3G 1A4. E-mail: [email protected]; Tel: +1 514 934 1934. Ext. 43030; Fax: +1 514 934 8249
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Summary

Background and objectives

Volatile anaesthetics have gained more popularity recently due to the potential for cardiac protection. Ultra-fast-track anaesthesia implies the immediate extubation after cardiac surgery. The purpose of this prospective randomized double-blind controlled study is to compare the cardioprotective effects of sevoflurane and isoflurane in off-pump cardiac bypass surgery.

Methods

Forty patients undergoing elective off-pump cardiac bypass surgery with high thoracic epidural analgesia and immediate extubation at the end of surgery were randomized into two groups. During surgery, anaesthesia was provided with either 1 minimum alvelolar anaesthetic concentration of sevoflurane or 1 minimum alvelolar anaesthetic concentration of isoflurane. Troponin-T, creatine kinase-MB, left ventricular wall motion anomalies, time to extubation, respiratory functions and haemodynamic parameters were compared between the two groups by analysis of variance.

Results

All patients were successfully extubated in the operating theatre with minimal postoperative pain. Serial creatine kinase-MB and troponin-T concentrations were not significantly different between the two volatile agents. Haemodynamic stability throughout surgery and contractility was not different between groups. However, extubation time was significantly shorter with sevoflurane (10 ± 5 min) compared to isoflurane (18 ± 4 min).

Conclusion

This study indicates that during off-pump cardiac bypass surgery, sevoflurane and isoflurane provide the same ischaemic cardioprotective effects. There is no difference for heart contractility and haemodynamic values during and after off-pump cardiac bypass surgery between the two agents. Sevoflurane allows a more rapid recovery from anaesthesia, but this does not translate into better pulmonary function or haemodynamics. Both agents are similar in ultra–fast-track off-pump cardiac bypass surgery.

Keywords

SURGERY CARDIACCARDIOPULMONARY BYPASSSEVOFLURANEISOFLURANETROPONIN TCREATININE KINASEMYOARDIAL ISCHAEMIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 230 - 236
Copyright
Copyright © European Society of Anaesthesiology 2008

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