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Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration
- Source :
- Anesthesiology, 101(2), 299-310. Lippincott Williams and Wilkins, Anesthesiology
- Publication Year :
- 2004
-
Abstract
- Background Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration. Methods Elective coronary surgery patients were randomly assigned to four different anesthetic protocols (n = 50 each). In a first group, patients received a propofol based intravenous regimen (propofol group). In a second group, propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass (SEVO pre group). In a third group, propofol was replaced by sevoflurane after completion of the coronary anastomoses (SEVO post group). In a fourth group, propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation (SEVO all group). Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively. Results Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group. Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group. In the SEVO pre and SEVO post groups, stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group. Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group. Conclusion In patients undergoing coronary artery surgery with cardiopulmonary bypass, the cardioprotective effects of sevoflurane were clinically most apparent when it was administered throughout the operation.
- Subjects :
- Male
Methyl Ethers
medicine.medical_specialty
Time Factors
Heart Diseases
Sevoflurane
Ventricular Function, Left
law.invention
law
Internal medicine
Troponin I
medicine
Cardiopulmonary bypass
Humans
Prospective Studies
Cardiac Surgical Procedures
Propofol
Aged
Cardiopulmonary Bypass
business.industry
Myocardium
Hemodynamics
Stroke volume
Middle Aged
Creatine
Intensive care unit
Coronary Vessels
Anesthesiology and Pain Medicine
Anesthesia
Anesthetic
Anesthetics, Inhalation
Ischemic Preconditioning, Myocardial
Cardiology
Anesthesia, Intravenous
Ischemic preconditioning
Female
business
Anesthesia, Inhalation
Anesthetics, Intravenous
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 00033022
- Volume :
- 101
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Anesthesiology
- Accession number :
- edsair.doi.dedup.....2c0486668c5fe755e8a7017f53eab988