Myocardial protection with volatile anesthetic agents have been suggested by multiple studies. These studies, however, are scattered and are often limited to a particular aspect of cardiac anesthesia. Older inhalational agents like halothane is known to cause significant hepatic damage in patients undergoing long duration surgeries while isoflurane is known to have marked vasodilating properties that also affects the coronary arteries leading to coronary “steal” phenomenon. Additionally, newer agents, like sevoflurane and desflurane, have shown more prominent cardioprotective effects than older agents. We searched ScholarOne, Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. The medical subject headings (MeSH) terms “anaesthesia, inhalational,” “anaesthesia, intravenous, or TIVA,” and “Cardiac anaesthesia or Cardiac Surgery” were used. Additional studies were identified by review of the reference sections of all eligible studies. The aim of this review article is to bring together the evidences with newer inhalational agents and provide a holistic view of their benefits and shortcomings in cardiac anesthesia.

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Background. Blood conservation has remained a challenge in the field of cardiac surgery, especially since the advent of OPCAB. This has led us to conduct this study to compare the efficacy of desmopressin, aprotinin bolus doses and aprotinin continuous infusion in controlling the periorative bleeding.Methods. 80 consecutive patients receiving antiplatelets drugs undergoing OPCAB were subjected to one of the three groups. Group A (n=20) received desmopressin 0.2mg/kg over 20 min after induction of anaesthesia. Group B (n=20) received aprotinin 15000 units/kg over 20 min after induction and with protamine. Group C (n=20) received aprotinin 8000 units/Kg over 20 min at induction, repeated with protamine and infusion of aprotinin 4000 units/kg/hr intraoperative & 2000 units/Kg/hr postoperative over 5 hours. Group D (n=20) served as control. Shed mediastinal blood (SMB) was reinfused intraoperatively and postoperatively. Postoperative drainage for first 12 hours was noted. Routing coagulation tests, activated clotting time (ACT) and Thromboelastography (TEG) were used for monitoring coagulation and as guide for blood product transfusion.Results. Postoperative drainage was minimum (198.52±101.35) P=0.0836 and postoperative autotransfusion was significantly low (p=0.0096) in group C. There was no significant difference (P>0.05) between groups in total auto transfusion, rise in serum creatinine and coagulation profile. Surgical field was highly satisfactory in continuous aprotinin group. ANOVA and chi square test were used for statistical significance.Conclusion. Combination of peri-operative autotransfusion and pharmacological methods practically eliminates the need of homologous blood transfusion. Continuous infusion of aprotinin is better than other methods studied. (Ind J Thorac Cardiovasc Surg, 2002; 18: 110-114)

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