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Cardiac protection by volatile anaesthetics: a multicentre randomized controlled study in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Published online by Cambridge University Press:  01 April 2007

L. Tritapepe ,
G. Landoni ,
F. Guarracino ,
F. Pompei ,
M. Crivellari ,
D. Maselli ,
M. De Luca ,
O. Fochi ,
S. D’Avolio  and
E. Bignami
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L. Tritapepe
Affiliation:
Università degli Studi ‘La Sapienza’ di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy
G. Landoni
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
F. Guarracino
Affiliation:
Azienda OspedalieraUniversitaria Pisana, Cisanello Hospital, Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Pisa, Italy
F. Pompei
Affiliation:
Università degli Studi ‘La Sapienza’ di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy
M. Crivellari
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
D. Maselli
Affiliation:
Azienda OspedalieraUniversitaria Pisana, Cisanello Hospital, Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Pisa, Italy
M. De Luca
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
O. Fochi
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
S. D’Avolio
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
E. Bignami
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
M. G. Calabrò
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
A. Zangrillo
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
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Summary

Background and objectives

To evaluate the effects of total intravenous anaesthesia vs. volatile anaesthesia on cardiac troponin release in coronary artery bypass grafting with cardiopulmonary bypass, we performed a multicentre randomized controlled study to compare postoperative cardiac troponin release in patients receiving two different anaesthesia plans.

Methods

We randomly assigned 75 patients to propofol (intravenous anaesthetic) and 75 patients to desflurane (volatile anaesthetic) in addition to an opiate-based anaesthesia for coronary artery bypass grafting. Peak postoperative troponin I release was measured as a marker of myocardial necrosis.

Results

There was a significant (P < 0.001) difference in the postoperative median (25th–75th percentiles) peak of troponin I in patients receiving propofol 5,5 (2,3–9,5) ng dL−1 when compared to patients receiving desflurane 2,5 (1,1–5,3) ng dL−1. The median (interquartile) troponin I area under the curve analysis confirmed the results: 68 (30.5–104.8) vs. 36.3 (17.9–86.6) h ng dL−1 (P = 0.002). Patients receiving volatile anaesthetics had reduced need for postoperative inotropic support (24/75, 32.0% vs. 31/75, 41.3%, P = 0.04), and tends toward a reduction in number of Q-wave myocardial infarction, time on mechanical ventilation, intensive care unit and overall hospital stay.

Conclusions

Myocardial damage measured by cardiac troponin release could be reduced by volatile anaesthetics in coronary artery bypass surgery.

Keywords

INHALATION ANAESTHETICSCARDIOPULMONARY BYPASSTROPONINCORONARY ARTERY BYPASS GRAFTINGCORONARY ARTERY BYPASS SURGERY
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 323 - 331
Copyright
Copyright © European Society of Anaesthesiology 2006

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