Document Detail


Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients.
MedLine Citation:
PMID:  12883404     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The present study investigated the effects of propofol, desflurane, and sevoflurane on recovery of myocardial function in high-risk coronary surgery patients. High-risk patients were defined as those older than 70 yr with three-vessel disease and an ejection fraction less than 50% with impaired length-dependent regulation of myocardial function. METHODS: Coronary surgery patients (n = 45) were randomly assigned to receive either target-controlled infusion of propofol or inhalational anesthesia with desflurane or sevoflurane. Cardiac function was assessed perioperatively and during 24 h postoperatively using a Swan-Ganz catheter. Perioperatively, a high-fidelity pressure catheter was positioned in the left and right atrium and ventricle. Response to increased cardiac load, obtained by leg elevation, was assessed before and after cardiopulmonary bypass (CPB). Effects on contraction were evaluated by analysis of changes in dP/dt(max). Effects on relaxation were assessed by analysis of the load-dependence of myocardial relaxation. Postoperative levels of cardiac troponin I were followed for 36 h. RESULTS: After CPB, cardiac index and dP/dt(max) were significantly lower in patients under propofol anesthesia. Post-CPB, leg elevation resulted in a significantly greater decrease in dP/dt(max) in the propofol group, whereas the responses in the desflurane and sevoflurane groups were comparable with the responses before CPB. After CPB, load dependence of left ventricular pressure drop was significantly higher in the propofol group than in the desflurane and sevoflurane group. Troponin I levels were significantly higher in the propofol group. CONCLUSIONS: Sevoflurane and desflurane but not propofol preserved left ventricular function after CPB in high-risk coronary surgery patients with less evidence of myocardial damage postoperatively.
Authors:
Stefan G De Hert; Stefanie Cromheecke; Pieter W ten Broecke; Els Mertens; Ivo G De Blier; Bernard A Stockman; Inez E Rodrigus; Philippe J Van der Linden
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  99     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-07-28     Completed Date:  2003-08-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  314-23     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic and Vascular Anesthesia, University Hospital Antwerp, Belgium. sdehert@uia.ac.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthetics, Inhalation*
Anesthetics, Intravenous*
Biological Markers
Coronary Artery Bypass*
Female
Heart / physiology*
Hemodynamics / drug effects
Humans
Isoflurane* / analogs & derivatives*
Male
Methyl Ethers*
Myocardial Contraction / drug effects
Postoperative Period
Propofol*
Stroke Volume / drug effects
Troponin I / blood
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Biological Markers; 0/Methyl Ethers; 0/Troponin I; 2078-54-8/Propofol; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 57041-67-5/desflurane
Comments/Corrections
Comment In:
Anesthesiology. 2004 Apr;100(4):1038-9; author reply 1039-40   [PMID:  15087655 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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