Sedation with sevoflurane in postoperative cardiac surgery: influence on troponin T and creatinine values

Introduction: To compare the potential beneficial effects on markers of myocardial injury (troponin T) and renal function between sedation with sevoflurane vs propofol after cardiac surgery using extracorporeal cardiopulmonary bypass. Methods: A prospective study with sequential selection of patients undergoing coronary or coronary and valve cardiac surgery. Intraoperative anesthesia consisted in sevoflurane and remifentanil, while in the postoperative period patients were divided in two groups to receive sedation with either sevoflurane through the AnaConDa (c) system or propofol. The patients were sedated during a minimum of 120 minutes. Markers of myocardial injury and plasmatic creatinine were measured 4, 12, 24, and 48 hours after surgery. Results: Data from 129 patients, 62 sedated with propofol and 67 with sevoflurane, were analyzed. The analysis of the troponin T levels showed differences 12 and 48 hours after admission. Mean values at 12 hours were 0.89 (standard deviation 0.55) mu g. L-1 in the propofol group and 0.69 (standard deviation 0.40) mu g. L-1 in the sevoflurane group (p=0.026). TnT levels at 48 hours were 0.60 (standard deviation 0.46) mu g. L-1 in the propofol group and 0.37 (standard deviation 0.26) mu g. L-1 in the sevoflurane group (p=0,007). No differences were found in the groups in the creatinine levels before discharge. Conclusions: The post-operative sedation with sevoflurane after cardiac surgery with cardiopulmonary bypass is a valid alternative to propofol. It does not increase the number of side effects related to kidney damage in patients with no prior renal disease, leading to reduced troponin T levels 12 and 48 hours after admission.