Document Detail


Myocardial protection by isoflurane vs. sevoflurane in ultra-fast-track anaesthesia for off-pump aortocoronary bypass grafting.
MedLine Citation:
PMID:  17894911     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
T Hemmerling; J-F Olivier; N Le; I Prieto; D Bracco
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2007-09-26
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  25     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-01-29     Completed Date:  2008-03-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  230-6     Citation Subset:  IM    
Affiliation:
McGill University Health Center, Hôtel-Dieu Hospital, Cardiac Surgery Department, Montréal, Québec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Analgesia, Epidural / methods
Anesthesia / methods*
Anesthesia Recovery Period
Anesthetics, Inhalation / therapeutic use
Biological Markers / blood
Cardiotonic Agents / therapeutic use*
Coronary Artery Bypass, Off-Pump*
Creatine Kinase / blood
Double-Blind Method
Female
Heart / drug effects*
Humans
Intubation, Intratracheal
Isoflurane / therapeutic use*
Male
Methyl Ethers / therapeutic use*
Middle Aged
Myocardial Contraction / drug effects
Pain, Postoperative / prevention & control
Prospective Studies
Time Factors
Treatment Outcome
Troponin T / blood
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Biological Markers; 0/Cardiotonic Agents; 0/Methyl Ethers; 0/Troponin T; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; EC 2.7.3.2/Creatine Kinase

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


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