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.
RCT Entities:
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: Marco Moscarelli; Prakash P Punjabi; Gamov I Miroslav; Paolo Del Sarto; Francesca Fiorentino; Gianni D Angelini Journal: J Cardiothorac Surg Date: 2015-01-20 Impact factor: 1.637
Authors: Leila Mahdavi; Mohammad Hasan Abdollahi; Ahmad Entezari; Ehsan Salehi; Habibollah Hosseini; Syed Hossein Moshtaghioon; Azam Rafie; Ali Akbar Rahimianfar Journal: Adv Biomed Res Date: 2015-05-11
Authors: Paulo Sérgio da Silva; Márcio Portugal Trindade Cartacho; Casimiro Cardoso de Castro; Marcello Fonseca Salgado Filho; Antônio Carlos Aguiar Brandão Journal: Rev Bras Cir Cardiovasc Date: 2015 Jul-Aug
Authors: Xiao Liu; Xiaopeng Liu; Ruike Wang; Hui Luo; Gang Qin; L U Wang; Zhi Ye; Qulian Guo; E Wang Journal: Exp Ther Med Date: 2016-03-24 Impact factor: 2.447
Authors: Philip M Jones; Daniel Bainbridge; Michael W A Chu; Philip S Fernandes; Stephanie A Fox; Ivan Iglesias; Bob Kiaii; Ronit Lavi; John M Murkin Journal: Can J Anaesth Date: 2016-07-27 Impact factor: 6.713