Cardioprotective efficacy of sevoflurane vs. propofol during induction and/or maintenance in patients undergoing coronary artery revascularization surgery without pump: A randomized trial

Orriach, José Luis Guerrero; Ortega, M. Galán; Fernández, A; Aliaga, M. Ramirez; Cortes, Marimon; Villanueva, Daniel Ariza; Vela, Agustín; Torres, Juan Alcaide; Fernandez, Concepción Santiago; Gonzalez, E. Matute; Marcos, E. Alsina; Belmonte, Juan Jose Escalona; Navarro, Manuel Rubio; Sánchez, L. Garrido; Mañas, José Cruz

doi:10.1016/j.ijcard.2017.04.105

Cited by 20 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, a randomized study by Likhvantsev et al, with 900 patients, demonstrated that the use of sevo urane reduced the length of hospital stay (10 [9-11] days vs. 14 [10][11][12][13][14][15][16] days, p < 0,001), the levels of post PCI troponin I (0.18 ng/ml vs. 0.57 at 24 h, p < 0,001) and NT-pro BNP (633 pg/ml vs. 878 t 24 h, p < 0.001; 482 vs. 1036 at 48 h, p < 0.001), and was even capable of impacting the one-year mortality rate (17.8% vs. 24.8%, p = 0.03) when compared to intravenous anesthetic in cardiac surgeries 16 . Of note, a recent metanalysis failed to show impact of inhale anesthetic in mortality in non-cardiac surgeries (OR = 1.31; 95% CI: 0.83 to 2.05; p = 0.242) 17 .…”

Section: Discussionmentioning

confidence: 99%

“…The use of these anesthetic agents for prevention/reduction of myocardial damage after coronary revascularization (CABG or PCI) is still controversial. Although few small size trials and metanalysis have suggested a bene t in reduction of myocardial damage with their use [7][8][9][10][11] , a recent, well designed, large (n=5,400 patients), randomized trial failed to demonstrate differences with respect of death of any cause and myocardial infarction in patients undergoing CABG with intravenous vs. volatile anesthesia 12 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: prospective randomized clinical trial

Rossi,

Nigro,

Braga

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Markers of myocardial injury, such as creatine kinase myocardial band (CK-MB mass), are elevated in up to 30% of patients undergoing percutaneous coronary intervention (PCI) with stent deployment. This elevation represents myocardial injury that can impact the patient in the long term, including the risk of death. Sevoflurane, an inhaled anesthetic, may have cardioprotective properties, benefiting patients undergoing PCI.Methods: Randomized (1:1), double-blind, placebo-controlled trial enrolling patients with CAD eligible for PCI. The primary objective was to compare serum CK-MB mass raise in both groups. Additionally, we compared substantial elevations in CK-MB mass (defined as > 5x the upper limit of normal), length of stay in the ICU and in hospital, and one-year mortality.Results: 1,254 patients were randomized to receive sevoflurane (2% inspired fraction) or placebo (oxygen alone) for 30 minutes prior to PCI. Patients having experienced acute MI within 72h and those with stents in SVG were excluded. Sevoflurane was unable to promote cardioprotection, as determined by CK-MB mass levels (sevoflurane group: 2.52 ± 9.64; control group: 1.84 ± 8.58; p = 0.32). No effect was noticed on the reduction among patients who increase marker levels (prevalence of increase in CK-MB mass greater than the upper limit of normality = 30.8% in the sevoflurane group and 28.9% in the control group; p = 0.33; 4.6% vs. 3.1%, respectively, for increases 5x above the upper limit of normality [p = 0.21]).Conclusion: Sevoflurane failed to reduce myocardial injury after PCI. Therefore, its usage should not be routinely recommended.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: prospective randomized clinical trial

Rossi,

Nigro,

Braga

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…RCTs involving 244 patients undergoing offpump CABG who received VA (sevoflurane, desflurane, or isoflurane) [26][27][28] demonstrated comparable hemodynamic parameters [26] with lower [28] or similar [26,27] cTnT and CK-MB levels postoperatively compared with those who received pTIVA [26][27][28]. When sevoflurane was used for intraoperative maintenance and postoperative sedation in 150 patients undergoing off-pump CABG, it was associated with lowered cTnI [29,30] and NT-proBNP [30] levels, reduced need for inotropic support [29,30], better preserved renal function [29], and shorter ICU LOS [29] compared with propofol or a combination of propofol and sevoflurane [29,30].…”

Section: Key Pointsmentioning

confidence: 99%

Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?

Makkad

Heinke

Kertai

2021

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewPerioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. Recent findingsRecent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery.

show abstract

“…Cardioprotection is exerted by desflurane through pre- and postconditioning, during the perioperative period of cardiac surgery involving induced ischemia (during extracorporeal circulation (ECC)) or when there is a high risk of coronary events secondary to ischemic heart disease [ 4 ]. ECC increases the risk of myocardial damage caused by existing heart disease or by a potential imbalance between oxygen supply and consumption [ 2 , 5 , 6 , 7 , 8 ]. As opposed to intravenous agents (propofol), inhaled anesthetics amplify enzymatic pathways according to the time of exposure and concentration administered; therefore, sustained perioperative administration should enhance the protective effects of inhaled anesthetics.…”

Section: Introductionmentioning

confidence: 99%

“…Firstly, they induce myocardial conditioning, thereby improving cardiac output and ultimately preserving cardiac function. Secondly, they provide nephroprotection through a similar mechanism [ 6 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study

Orriach

Malo-Manso

Galo

et al. 2022

Life

View full text Add to dashboard Cite

Introduction: The cardioprotective effect of halogenated drugs in cardiac surgery has been the subject of several studies. However, there is scarcity of data on their potential nephroprotective effects. Aortic valve replacement and coronary revascularization are the most frequent cardiac surgery procedures. The objective of this explorative study was to examine the effect of desflurane vs. propofol on renal function, when administered in aortic valve replacement surgery, including the extracorporeal circulation period. Method: A quasi-experimental prospective study was performed in 60 patients, who were allocated to receive either desflurane or propofol intraoperatively during aortic valve replacement surgery. As a hypnotic, group 1 received propofol, whereas group 2 received desflurane. Markers of renal function and level of cardiac preservation were determined based on biochemical parameters (troponin I, NTProBNP). Results: In the propofol group, there were significant variations between postoperative values of urinary NGAL and creatinine and baseline values. In contrast, no variations were found in the desflurane group in terms of hemodynamic parameters and myocardial damage. Conclusions: The use of propofol vs. desflurane during aortic valve replacement surgery is associated with a decrease in renal function.

show abstract

Cardioprotective efficacy of sevoflurane vs. propofol during induction and/or maintenance in patients undergoing coronary artery revascularization surgery without pump: A randomized trial

Cited by 20 publications

References 38 publications

Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: prospective randomized clinical trial

Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: prospective randomized clinical trial

Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?

Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study

Contact Info

Product

Resources

About