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Isoflurane may not influence postoperative cardiac troponin I release and clinical outcome in adult cardiac surgery

Published online by Cambridge University Press:  23 December 2004

J.-L. Fellahi ,
X. Gue ,
E. Philippe ,
B. Riou  and
J.-L. Gerard
J.-L. Fellahi
Affiliation:
Centre Hospitalier Privé Saint-Martin, Caen, France
X. Gue
Affiliation:
Centre Hospitalier Privé Saint-Martin, Caen, France
E. Philippe
Affiliation:
Centre Hospitalier Privé Saint-Martin, Caen, France
B. Riou
Affiliation:
Centre Hospitalo Universitaire Pitié-Salpêtrière, Emergency Medical Department, Paris, France
J.-L. Gerard
Affiliation:
Centre Hospitalo Universitaire Côte de Nacre, Department of Anaesthesiology, Caen, France
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Abstract

Summary

Background and objective: Isoflurane has been shown experimentally to protect the myocardium against infarction but the clinical relevance of these findings is not yet well established. We therefore evaluated the effects of isoflurane administration before cardiopulmonary bypass (CPB) on postoperative cardiac troponin I (cTnI) release and clinical outcome in a large group of adult patients scheduled for cardiac surgery.

Methods: Three hundred and fifty-nine consecutive patients were included prospectively in an open observational study and divided into two groups according to whether or not isoflurane was administered before CPB. Postoperative cTnI release, in-hospital mortality, time to discharge from hospital, time to extubation and non-fatal postoperative cardiac events (number of internal cardioversions, need for inotropic support, ischaemic events, dysrhythmias and/or conduction abnormalities) were recorded.

Results: Two hundred and twenty-one (62%) patients did not receive isoflurane and 138 (38%) received isoflurane (1.3% [1.0–1.8%] minimum alveolar concentration over 22 [15–33] min). Postoperative cTnI release was not significantly different between the control and isoflurane groups (5.9 [1.0–336.8] vs. 6.0 [1.5–392.0] ng mL−1, P = 0.88). No significant differences were found in non-fatal cardiac events (63% vs. 57%, P = 0.22) and in-hospital mortality (1.8% vs. 1.4%, P = 0.79) between the control and isoflurane groups.

Conclusions: No significant effect was observed on postoperative cTnI release and in-hospital outcome when isoflurane was added to standardized intravenous anaesthesia before CPB in adult patients undergoing cardiac surgery.

Keywords

THORACIC SURGERY, CARDIAC SURGERYTROPONIN IANAESTHETICS INHALATION, isofluranePOSTOPERATIVE COMPLICATIONS, myocardial
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 9 , September 2004 , pp. 688 - 693
Copyright
2004 European Society of Anaesthesiology

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References

Kersten JR, Schmeling TJ, Hettrick DA, Pagel PS, Gross GJ, Warltier DC. Mechanism of myocardial protection by isoflurane: role of adenosine triphosphate-regulated potassium (KATP) channels. Anesthesiology 1996; 85: 794–807.Google Scholar
Cason BA, Gamperl AK, Slocum RE, Hickey RF. Anesthetic-induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Anesthesiology 1997; 87: 1182–1190.Google Scholar
Kersten JR, Schmeling TJ, Pagel PS, Gross GJ, Warltier DC. Isoflurane mimics ischemic preconditioning via activation of KATP channels: reduction of myocardial infarct size with an acute memory phase. Anesthesiology 1997; 87: 361–370.Google Scholar
Ismaeil MS, Tkachenko I, Gamperl AK, Hickey RF, Cason BA. Mechanisms of isoflurane-induced myocardial preconditioning in rabbits. Anesthesiology 1999; 90: 812–821.Google Scholar
Piriou V, Chiari P, Knezynsky S, et al. Prevention of isoflurane-induced preconditioning by 5-hydroxydecanoate and gadolinium: possible involvement of mitochondrial adenosine triphosphate-sensitive potassium and stretch-activated channels. Anesthesiology 2000; 93: 756–764.Google Scholar
Belhomme D, Peynet J, Louzy M, Launay JM, Kitakaze M, Menasche P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation 1999; 100 (Suppl): II340–II344.Google Scholar
Haroun-Bizri S, Khoury SS, Chehab IR, Kassa CM, Baraka A. Does isoflurane optimize myocardial protection during cardiopulmonary bypass? J Cardiothorac Vasc Anesth 2001; 15: 418–421.Google Scholar
De Hert SG, ten Broecke PW, Mertens E, et al. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology 2002; 97: 42–49.Google Scholar
De Hert SG, Cromheecke S, ten Broecke PW, et al. Effects of propofol, desflurane and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients. Anesthesiology 2003; 99: 314–323.Google Scholar
Julier K, da Silva R, Garcia C, et al. Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study. Anesthesiology 2003; 98: 1315–1327.Google Scholar
Vaage J, Valen G. Preconditioning and cardiac surgery. Ann Thorac Surg 2003; 75: S709–S714.Google Scholar
Alyanakian MA, Dehoux M, Chatel D, et al. Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery. J Cardiothorac Vasc Anesth 1998; 12: 288–294.Google Scholar
Fellahi JL, Léger P, Philippe E, et al. Pericardial cardiac troponin I release after coronary artery bypass grafting. Anesth Analg 1999; 89: 829–834.Google Scholar
Carrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann Thorac Surg 2000; 69: 435–440.Google Scholar
Lasocki S, Provenchère S, Benessiano J, et al. Cardiac troponin I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 2002; 97: 405–411.Google Scholar
Fellahi JL, Gué X, Richomme X, Monier E, Guillou L, Riou B. Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology 2003; 99: 270–274.Google Scholar
Yellon DM, Alkhulaifi AM, Pugsley WB. Preconditioning the human myocardium. Lancet 1993; 342: 276–277.Google Scholar
Jenkins DP, Pugsley WB, Alkhulaifi AM, Kemp M, Hooper J, Yellon DM. Ischemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery. Heart 1997; 77: 314–318.Google Scholar
Kaukoranta PK, Lepojarvi MP, Ylitalo KV, Kiviluoma KT, Peuhkurinen KJ. Normothermic retrograde blood cardioplegia with or without preceeding ischemic preconditioning. Ann Thorac Surg 1997; 63: 1268–1274.Google Scholar
Cremer J, Steinhoff G, Karck M, et al. Ischemic preconditioning prior to myocardial protection with cold blood cardioplegia in coronary surgery. Eur J Cardiothorac Surg 1997; 12: 753–758.Google Scholar
Teoh LK, Grant R, Hulf JA, Pugsley WB, Yellon DM. The effect of preconditioning (ischemic and pharmacological) on myocardial necrosis following coronary artery bypass graft surgery. Cardiovasc Res 2002; 53: 175–180.Google Scholar
Piriou V, Chiari P, Lhuillier F, et al. Pharmacological preconditioning: comparison of desflurane, sevoflurane, isoflurane and halothane in rabbit myocardium. Br J Anaesth 2002; 89: 486–491.Google Scholar
Heindl B, Reichle FM, Zahler S, Conzen PF, Becker BF. Sevoflurane and isoflurane protect the reperfused guinea pig heart by reducing postischemic adhesion of polymorphonuclear neutrophils. Anesthesiology 1999; 91: 521–530.Google Scholar
Coetzee JF, le Roux PJ, Genade S, Lochner A. Reduction of postischemic contractile dysfunction of the isolated rat heart by sevoflurane: comparison with halothane. Anesth Analg 2000; 90: 1089–1097.Google Scholar
Schultz JE, Hsu AK, Gross GJ. Morphine mimics the cardioprotective effect of ischemic preconditioning via a glibenclamide-sensitive mechanism in the rat heart. Circ Res 1996; 78: 1100–1104.Google Scholar
Zaugg M, Lucchinetti E, Spahn DR, Pasch T, Garcia C, Schaub MC. Differential effects of anesthetics on mitochondrial KATP channel activity and cardiomyocyte protection. Anesthesiology 2002; 97: 15–23.Google Scholar
Kokita N, Hara A. Propofol attenuates hydrogen peroxide-induced mechanical and metabolic derangements in the isolated rat heart. Anesthesiology 1996; 84: 117–127.Google Scholar
Ansley DM, Sun J, Visser WA, et al. High dose propofol enhances red cell antioxidant capacity during CPB in humans. Can J Anaesth 1999; 46: 641–648.Google Scholar
Ebel D, Schlack W, Comfere T, Preckel B, Thämer V. Effect of propofol on reperfusion injury after regional ischaemia in the isolated rat heart. Br J Anaesth 1999; 83: 903–908.Google Scholar
Wu ZK, Pehkonen E, Laurikka J, et al. The protective effects of preconditioning decline in aged patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2001; 122: 972–978.Google Scholar