Anesth Pain Med.  2012 Oct;7(4):320-324.

Comparison of cardioprotection between sevoflurane-remifentanil and midazolam-sufentanil total intravenous anesthesia during off-pump coronary artery bypass surgery

• Gil NS
• Shon YJ
• Hwang JY
• Choi SP
• Sim SE
• Huh J
• Min SW
• Kim CS
• Jeon YS
• Lee SY

Abstract

BACKGROUND
Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review.
METHODS
The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68), and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical, anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured.
RESULTS
All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover, there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1-5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009), 3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485 ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively).
CONCLUSIONS
Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG.

Keyword

Cardiac anesthesia; Myocardial protection; Preconditioning; Sevoflurane

MeSH Terms

Anesthesia
Anesthesia, Intravenous
Coronary Artery Bypass, Off-Pump
Humans
Inhalation
Intensive Care Units
Ischemia
Medical Records
Methyl Ethers
Midazolam
Myocardium
Postoperative Care
Retrospective Studies
Sufentanil
Troponin I
Methyl Ethers
Midazolam
Sufentanil
Troponin I