Sevoflurane vs. propofol in patients with coronary disease undergoing mitral surgery: a randomised study

被引:30
作者
Bignami, E. [1 ]
Landoni, G. [1 ,2 ]
Gerli, C. [1 ]
Testa, V. [1 ]
Mizzi, A. [1 ]
Fano, G. [1 ]
Nuzzi, M. [1 ]
Franco, A. [1 ]
Zangrillo, A. [1 ]
机构
[1] Univ Vita Salute San Raffaele, Dept Anesthesia & Intens Care, Milan, Italy
[2] Outcomes Res Consortium, Cleveland, OH USA
关键词
ARTERY-BYPASS SURGERY; VOLATILE ANESTHETICS; MYOCARDIAL PROTECTION; CARDIOPULMONARY BYPASS; CARDIAC PROTECTION; CARDIOPROTECTIVE PROPERTIES; CLINICAL-IMPLICATIONS; METAANALYSIS; ISOFLURANE; AGENTS;
D O I
10.1111/j.1399-6576.2011.02570.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Myocardial ischemic damage is reduced by volatile anaesthetics in patients undergoing low-risk coronary artery bypass graft surgery; few and discordant results exist in other settings. We therefore performed a randomised controlled trial (sevoflurane vs. propofol) to compare cardiac troponin release in patients with coronary disease undergoing mitral surgery. Methods: Patients with coronary artery disease undergoing mitral surgery were randomly allocated to receive either sevoflurane (50 patients) or propofol (50 patients) as main hypnotic. The primary endpoint of the study was peak post-operative cardiac troponin release defined as the maximum value among the post-operative values measured at intensive care unit arrival, 4 h later, on the first and second post-operative day. Results: There was no significant difference in post-operative peak troponin release, the median (25th-75th percentiles) values being 14.9 (10.1-22.1) ng/ml and 14.5 (8.8-17.6) ng/ml in the sevoflurane and propofol groups, respectively (P = 0.4). Fentanyl administration was different between the two groups: 1347 +/- 447 mg in patients receiving sevoflurane and 1670 +/- 469 mg in those receiving propofol, P = 0.002. The 1-year follow-up identified two patients who died in the propofol group ( one myocardial infarction and one low cardiac output syndrome) and one in the sevoflurane group ( myocardial infarction). Conclusion: In this study, patients with coronary artery disease undergoing mitral surgery did not benefit from the cardioprotective properties of halogenated anaesthetics. Sevoflurane anaesthesia was not associated to lower cardiac troponin release when compared with propofol anaesthesia.
引用
收藏
页码:482 / 490
页数:9
相关论文
共 40 条
[1]   Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery [J].
Bein, B ;
Renner, J ;
Caliebe, D ;
Scholz, J ;
Paris, A ;
Fraund, S ;
Zaehle, W ;
Tonner, PH .
ANESTHESIA AND ANALGESIA, 2005, 100 (03) :610-616
[2]   Role of cardiac biomarkers (troponin I and CK-MB) as predictors of quality of life and long-term outcome after cardiac surgery [J].
Bignami, Elena ;
Landoni, Giovanni ;
Crescenzi, Giuseppe ;
Gonfalini, Massimiliano ;
Bruno, Giovanna ;
Pappalardo, Federico ;
Marino, Giovanni ;
Zangrillo, Alberto ;
Alfieri, Ottavio .
ANNALS OF CARDIAC ANAESTHESIA, 2009, 12 (01) :22-26
[3]   Volatile Anesthetics Reduce Mortality in Cardiac Surgery [J].
Bignami, Elena ;
Biondi-Zoccai, Giuseppe ;
Landoni, Giovanni ;
Fochi, Oliviero ;
Testa, Valentina ;
Sheiban, Imad ;
Giunta, Francesco ;
Zangrillo, Alberto .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2009, 23 (05) :594-599
[4]   Myocardial protection at a crossroads - The need for translation into clinical therapy [J].
Bolli, R ;
Becker, L ;
Gross, G ;
Mentzer, R ;
Balshaw, D ;
Lathrop, DA .
CIRCULATION RESEARCH, 2004, 95 (02) :125-134
[5]   Anaesthetic-induced myocardial preconditioning: fundamental basis and clinical implications [J].
Chiari, P ;
Bouvet, F ;
Piriou, V .
ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION, 2005, 24 (04) :383-396
[6]   Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery [J].
Conzen, PF ;
Fischer, S ;
Detter, C ;
Peter, K .
ANESTHESIOLOGY, 2003, 99 (04) :826-833
[7]   Cardioprotective properties of sevoflurane in patients undergoing aortic valve replacement with cardiopulmonary bypass [J].
Cromheecke, Stefanie ;
Pepermans, Veronik ;
Hendrickx, Ellen ;
Lorsomradee, Sur ;
ten Broecke, Pieter W. ;
Stockman, Bernard A. ;
Rodrigus, Inez E. ;
De Hert, Stefan G. .
ANESTHESIA AND ANALGESIA, 2006, 103 (02) :289-296
[8]   A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery [J].
De Hert, S. ;
Vlasselaers, D. ;
Barbe, R. ;
Ory, J-P. ;
Dekegel, D. ;
Donnadonni, R. ;
Demeere, J-L. ;
Mulier, J. ;
Wouters, P. .
ANAESTHESIA, 2009, 64 (09) :953-960
[9]   Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration [J].
De Hert, SG ;
Van der Linden, PJ ;
Cromheecke, S ;
Meeus, R ;
Nelis, A ;
Van Reeth, V ;
ten Broecke, PW ;
De Blier, IG ;
Stockman, BA ;
Rodrigus, IE .
ANESTHESIOLOGY, 2004, 101 (02) :299-310
[10]   Cardioprotection with volatile anesthetics: Mechanisms and clinical implications [J].
De Hert, SG ;
Turani, F ;
Mathur, S ;
Stowe, DF .
ANESTHESIA AND ANALGESIA, 2005, 100 (06) :1584-1593