Endocrine stress response and myocardial outcome under balanced anesthesia with sevoflurane or TIVA with propofol in patients undergoing CABG

This study was undertaken to compare the influence of balanced anesthesia utilizing sevoflurane and fentanyl with total intravenous anesthesia (TIVA) utilizing propofol and fentanyl on endocrine stress response in CABG patients. 40 patients scheduled for CABG were prospectively and randomly assigned to two groups. Group A (n=20) received balanced anesthesia with sevoflurane, fentanyl and pancuronium whereas group B (n=20) received TIVA with propofol, fentanyl and pancuronium. EEG and AEP were used to ensure a comparable depth of anesthesia. During 7 time points (T1 baseline, T2 intubation, T3 sternotomy, T4 aortic cannulation, T5 30 min on pump, T6 separation from CPB, T7 end of surgery), hemodynamic parameters and plasma levels of epinephrine, norepinephrine, ADH, ACTH and cortisol were determined. CK-MB, troponin T were measured postoperatively. Outcome was followed for 24 months. Biometric data were comparable between the groups. Plasma levels of epinephrine were significantly lower in group B than in group A at T4 (106 vs 63 pg/ml) and T5 (308 vs 67 pg/ml). Group mean value of ADH was lower in group B (p=0.02). Plasma levels of cortisol in group B were significantly lower at T5 (197 vs 140 ng/ml) and T7 (173 vs 120 ng/ml), when compared to group A. A positive correlation between ADH levels and the postoperative length of hospital stay was found. No significant differences occurred with respect to myocardial markers and hemodynamic data. At comparable depth of anesthesia, the endogenous stress response during TIVA with propofol was less pronounced than during balanced anesthesia with sevoflurane.