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

• Published in: European journal of anaesthesiology Vol. 24; no. 4; pp. 323 - 331
• Main Authors: Tritapepe, L., Landoni, G., Guarracino, F., Pompei, F., Crivellari, M., Maselli, D., Luca, M. De, Fochi, O., D’Avolio, S., Bignami, E., Calabrò, M. G., Zangrillo, A.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-04-2007; European Society of Anaesthesiology; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Aged; Anesthetics, Inhalation - pharmacology; Cardiopulmonary Bypass; Coronary Artery Bypass - methods; Female; Heart - drug effects; Heart - physiopathology; Humans; Ischemic Preconditioning, Myocardial; Isoflurane - analogs & derivatives; Isoflurane - pharmacology; Male; Middle Aged; Propofol - pharmacology; Troponin I - blood; INHALATION ANAESTHETICS; CARDIOPULMONARY BYPASS; CORONARY ARTERY BYPASS GRAFTING; CORONARY ARTERY BYPASS SURGERY; TROPONIN
• ISSN: 0265-0215; 1365-2346
• DOI: 10.1017/S0265021506001931

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 when compared to patients receiving desflurane 2,5 (1,1-5,3) ng dL. The median (interquartile) troponin I area under the curve analysis confirmed the results68 (30.5-104.8) vs. 36.3 (17.9-86.6) h ng dL (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.