Comparison of cardioprotection between sevoflurane-remifentanil and midazolam-sufentanil total intravenous anesthesia during off-pump coronary artery bypass surgery.
- Author:
Nam Su GIL
1
;
Yoon jung SHON
;
Jin Young HWANG
;
Seung Pyo CHOI
;
Sung Eun SIM
;
Jin HUH
;
Seong Won MIN
;
Chong Soo KIM
;
Yun Seok JEON
;
Sue Young LEE
Author Information
1. Department of Anesthesiology and Pain Medicine, Boramae Hospital, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Cardiac anesthesia;
Myocardial protection;
Preconditioning;
Sevoflurane
- MeSH:
Anesthesia;
Anesthesia, Intravenous;
Coronary Artery Bypass, Off-Pump;
Humans;
Inhalation;
Intensive Care Units;
Ischemia;
Medical Records;
Methyl Ethers;
Midazolam;
Myocardium;
Postoperative Care;
Retrospective Studies;
Sufentanil;
Troponin I
- From:Anesthesia and Pain Medicine
2012;7(4):320-324
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review. METHODS: The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68), and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical, anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured. RESULTS: All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover, there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1-5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009), 3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485 ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively). CONCLUSIONS: Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG.
