Cardioprotective effect of sevoflurane in patients with coronary artery disease undergoing vascular surgery

Bassuoni, Ahmed Sobhy; Amr, Yasser Mohamed

doi:10.4103/1658-354x.97024

Cited by 14 publications

(5 citation statements)

References 20 publications

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“…A meta-analysis of studies enrolling over 6,200 patients undergoing noncardiac surgery did not find myocardial infarction or death in the studies reviewed, which limited analysis of choice of anesthetic technique impact on clinically relevant outcomes [120]. However, Bassuoni et al reported a beneficial effect of VA administration compared to propofol anesthesia [121]. They found VA administration was associated with less myocardial ischemia and troponin release after noncardiac peripheral vascular surgery in a study of 126 patients who did not have significant additional comorbid conditions.Recommendations from the American College of Cardiology/American Heart Association guidelines that state that patients at risk for myocardial infarction during non-cardiac surgery would benefit from pretreatment with gas anesthesia, if hemodynamically stable [122].…”

Section: Introductionmentioning

confidence: 99%

The role of Volatile Anesthetics in Cardioprotection: a systematic review

Allen

Krafft

Leitzke

et al. 2012

Medical Gas Research

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This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery.

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Section: Introductionmentioning

confidence: 99%

The role of Volatile Anesthetics in Cardioprotection: a systematic review

Allen

Krafft

Leitzke

et al. 2012

Medical Gas Research

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“…In recent years, foreign clinical studies have shown that9 a reasonable adjustment of the anesthesia maintenance drug program can effectively reduce the risk of postoperative POCD and reduce damage to central nervous system function. Cell culture experiments confirm that10,11 volatile anesthetics (isoflurane, sevoflurane, desflurane) can induce apoptosis and increase the formation of beta-amyloid protein. Similarly, with the increase of desflurane dosage, the degree of oligomerization of beta-amyloid protein also increases.…”

Section: Discussionmentioning

confidence: 83%

Comparison of effects of propofol versus sevoflurane for patients undergoing cardiopulmonary bypass cardiac surgery

Tang¹,

Huang²,

Zhang³

et al. 2019

Pak J Med Sci

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Objective: To compare the effects of propofol versus sevoflurane on the outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: A total of 110 patients undergoing cardiac surgery with CPB in our hospital from January 2015 to June 2017 were randomly divided into 2 groups (n=55): Group A, in which anesthesia was maintained with sevoflurane, and Group B, in which anesthesia was maintained with propofol. The MMSE score before and after operation, perioperative laboratory index, incidence of postoperative cognitive dysfunction (POCD) and incidence of adverse events between the two groups were compared. Results: The MMSE score was significantly higher in Group B than in Group A after anesthesia (p<0.05). Serum levels of the brain injury markers neuron-specific enolase, S100β and matrix metalloproteinase 9 were significantly lower in Group B than in Group A (p<0.05). POCD incidence at 12 hour and 24 hour after operation was significantly lower in Group B than in Group A (p<0.05). There were no significant differences in the incidence of low cardiac output and thoracotomy bleeding between two groups. Conclusion: Compared with sevoflurane, the use of propofol during cardiac surgery with CPB can efficiently improve postoperative cognitive function without increasing the risk of adverse reactions. doi: https://doi.org/10.12669/pjms.35.4.1279 How to cite this:Tang S, Huang W, Zhang K, Chen W, Xie T. Comparison of effects of propofol versus sevoflurane for patients undergoing cardiopulmonary bypass cardiac surgery. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1279 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…For example in the study conducted by Parker et al 19 and Bennett et al, 41 it was shown the protective effect in sevoflurane and isoflurane was similar and no changes were observed in troponin levels using the two drugs. Two studies 28,42 reported that sevoflurane provides better hemodynamic and protective conditions in the heart.…”

Section: Discussionmentioning

confidence: 99%

Comparing cardiac troponin levels using sevoflurane and isofluranein patients undergoing cardiac surgery: a systematic review and metaanalysis

Hosseinifard

Ghadimi

Kaveh

et al. 2020

J Cardiovasc Thorac Res

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Introduction: Cardiac troponin is one of the heart biomarkers and its high levels correlates with a high risk of cardiomyocytes damage. This study aimed to compare sevoflurane and isoflurane effect on troponin levels in patients undergoing cardiac surgery. Methods: We systematically searched for RCTs which had been published in Cochrane library, PubMed, Web of science, CRD, Scopus, and Google Scholar by the end of February 30th, 2019. The quality of articles was evaluated with the Cochrane checklist. GRADE was used for quality of evidence for this meta-analysis. Meta-analysis was done based on random or fixed effect model. Results: Five studies with total of 190 (sevoflurane) and 191 (isoflurane) patients were included. The results showed that pooled mean difference of troponin levels between the two groups was significant at ICU admission time and 24 hours after entering. The comparison of troponin level changes between the two groups (baseline = at time ICU) in 24 and 48 hours after ICU admission was significant. Conclusion: This meta-analysis showed that blood troponin levels were significantly lower at the time of arrival in ICU with isoflurane and after 24 hours with sevoflurane. Generally, given the small mean difference between isoflurane and sevoflurane, it seems that none of the medications has a negative effect on the cardiac troponin level. Article info TUOMS P R E S SHosseinifard et al J Cardiovasc Thorac Res, 2020, 12(1), 1-9 2 Aim of the Review In this regard, the aim of this study was to compare the effect of isoflurane and sevoflurane on troponin levels in patients undergoing cardiac surgery in a systematic review and meta-analysis. The results of this study would help clinicians obtain evidence based on clinical evidence and select the best inhalational anesthetic agent. MethodsThis was a systematic review and meta-analysis study that utilized randomized controlled trials (RCTs) to compare the effects of sevoflurane and isoflurane on troponin levels in patients with cardiac surgery, without any time constraints and based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 23

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Cardioprotective effect of sevoflurane in patients with coronary artery disease undergoing vascular surgery

Cited by 14 publications

References 20 publications

The role of Volatile Anesthetics in Cardioprotection: a systematic review

The role of Volatile Anesthetics in Cardioprotection: a systematic review

Comparison of effects of propofol versus sevoflurane for patients undergoing cardiopulmonary bypass cardiac surgery

Comparing cardiac troponin levels using sevoflurane and isofluranein patients undergoing cardiac surgery: a systematic review and metaanalysis

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