This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (33) Citing Articles via Google Scholar Google Scholar Articles by Bein, B. Articles by Tonner, P. H. Search for Related Content PubMed PubMed Citation Articles by Bein, B. Articles by Tonner, P. H. Related Collections Obstetrics Surgery Pharmacology

---

CARDIOVASCULAR ANESTHESIA

Sevoflurane but Not Propofol Preserves Myocardial Function During Minimally Invasive Direct Coronary Artery Bypass Surgery

Department of Anaesthesiology and Intensive Care Medicine and Department of Cardiothoracic and Vascular Surgery University Hospital Schleswig-Holstein, Campus Kiel, Germany

Address correspondence and reprint requests to Berthold Bein, MD, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg, 21, D-24105 Kiel, Germany. Address e-mail to bein{at}anaesthesie.uni-kiel.de.

Volatile anesthetics exert cardioprotective properties in experimental and clinical studies. We designed this study to investigate the effects of sevoflurane on left ventricular (LV) performance during minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. Fifty-two patients scheduled for MIDCAB surgery were randomly assigned to a propofol or a sevoflurane group. Apart from the anesthetics used, there was no difference in surgical and anesthetic management. After determination of cardiac troponin T, creatine kinase, and creatine kinase MB, electrocardiographic (ECG) data and echocardiography variables (myocardial performance index and early to atrial filling velocity ratio) the left anterior descending coronary artery (LAD) was clamped until anastomosis with the left internal mammary artery was completed. During LAD occlusion and during reperfusion, echocardiography measurements were repeated. Blood samples were obtained repeatedly for up to 72 h. After LAD occlusion, myocardial performance index and early to atrial filling velocity ratio in the propofol group deteriorated significantly from 0.40 ± 0.12 and 1.29 ± 0.35 to 0.49 ± 0.10 and 1.13 ± 0.22, respectively, whereas there was no change in the sevoflurane group. In the propofol group myocardial performance index remained increased (0.47 ± 0.11) compared with baseline during reperfusion. There were no significant differences in ECG and laboratory values between groups. In conclusion, during a brief period of ischemia in patients undergoing MIDCAB surgery, sevoflurane preserved myocardial function better than propofol.

This article has been cited by other articles:

				American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery J. Am. Coll. Cardiol., November 2, 2009; (2009) j.jacc.2009.07.010v1. [Full Text] [PDF]

				S. Lorsomradee, S. Cromheecke, S. Lorsomradee, and S. G De Hert Cardioprotection with Volatile Anesthetics in Cardiac Surgery Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 256 - 264. [Abstract] [Full Text] [PDF]

				M. Carles, J. Dellamonica, J. Roux, D. Lena, J. Levraut, J. F. Pittet, P. Boileau, and M. Raucoules-Aime Sevoflurane but not propofol increases interstitial glycolysis metabolites availability during tourniquet-induced ischaemia reperfusion Br. J. Anaesth., January 1, 2008; 100(1): 29 - 35. [Abstract] [Full Text] [PDF]

				E. Lucchinetti, M. Jamnicki, G. Fischer, and M. Zaugg Preconditioning by Isoflurane Retains Its Protection Against Ischemia-Reperfusion Injury in Postinfarct Remodeled Rat Hearts Anesth. Analg., January 1, 2008; 106(1): 17 - 23. [Abstract] [Full Text] [PDF]

				M. Zaugg Is protection by inhalation agents volatile? Controversies in cardioprotection Br. J. Anaesth., November 1, 2007; 99(5): 603 - 606. [Full Text] [PDF]

				L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]

				L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]

				R. Pirracchio, B. Cholley, S. De Hert, A. C. Solal, and A. Mebazaa Diastolic heart failure in anaesthesia and critical care Br. J. Anaesth., June 1, 2007; 98(6): 707 - 721. [Abstract] [Full Text] [PDF]

				J. A. Symons and P. S. Myles Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis Br. J. Anaesth., August 1, 2006; 97(2): 127 - 136. [Abstract] [Full Text] [PDF]

				S. Cromheecke, V. Pepermans, E. Hendrickx, S. Lorsomradee, P. W. ten Broecke, B. A. Stockman, I. E. Rodrigus, and S. G. De Hert Cardioprotective properties of sevoflurane in patients undergoing aortic valve replacement with cardiopulmonary bypass. Anesth. Analg., August 1, 2006; 103(2): 289 - 96, table of contents. [Abstract] [Full Text] [PDF]

				T. Luo and Z. Xia A small dose of hydrogen peroxide enhances tumor necrosis factor-alpha toxicity in inducing human vascular endothelial cell apoptosis: reversal with propofol. Anesth. Analg., July 1, 2006; 103(1): 110 - 116. [Abstract] [Full Text] [PDF]

				R. Hanss, B. Bein, P. Turowski, E. Cavus, M. Bauer, M. Andretzke, M. Steinfath, J. Scholz, and P. H. Tonner The influence of xenon on regulation of the autonomic nervous system in patients at high risk of perioperative cardiac complications Br. J. Anaesth., April 1, 2006; 96(4): 427 - 436. [Abstract] [Full Text] [PDF]

				S. G. De Hert Volatile Anesthetics and Cardiac Function Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 33 - 42. [Abstract] [PDF]