Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes

Abstract

Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3–5 mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h), while P group (n = 25) received propofol infusion (5-6 mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05). When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG.

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

“…MAP and HR had smaller fluctuations in patients in group S than those in group P. Patients for EVL and EVS in the current study often have acute or chronic blood loss. Propofol may be associated with diminished myocardial contractility, decreased cardiac output, reduced ability of the cardiovascular system to respond to stress (30) and preoperative fasting, all of which lead to relative or absolute hypovolemia (31). Therefore, in the present study, more ephedrine was used in group P than Figure 5.…”

Effects of dexmedetomidine on stress hormones in patients undergoing cardiac valve replacement: a randomized controlled trial

“…Increased secretion of surgical stress response associated hormones could cause tachycardia and elevate myocardial oxygen demand, peripheral vascular resistance, and oxygen consumption. Moreover, α-receptor activated sympathetic nerve stimulation may also lead to contraction of the coronary artery inducing myocardial ischemia [7]. Clinically, administration of anesthetic drugs to alleviate stress, could be effective in decreasing postoperative complications and mortality [8].…”

Total Intravenous Anesthesia was Associated With Better Survival Outcomes After Coronary Artery Bypass Grafting: A Retrospective Cohort Study With 3-Year Follow-Up in South Korea

“…[18][19][20] In this context, a previous RCT reported that compared with volatile anesthesia, TIVA could control stress and hemodynamic response in patients undergoing CABG. 21 However, there has been no report that TIVA is associated with a better survival outcome than inhalation anesthesia; therefore, the authors' results should be interpreted with care. Although propofol-based TIVA has been reported to lower the inflammatory effect during CABG, 18,19 the major side effect of propofol should be considered.…”