Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Bignami, Elena; Guarnieri, Marcello; Pieri, Marina; Simone, Francesco De; Rodriguez, Alcira; Cassarà, Luigi; Lembo, Rosalba; Landoni, Giovanni; Zangrillo, Alberto

doi:10.1177/0267659117701562

Cited by 25 publications

(19 citation statements)

References 33 publications

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“…Several clinical studies and meta-analyses have demonstrated the contribution of a potential cardioprotective strategy by sevoflurane postconditioning. 17,22,23,40 Related fundamental research assumed the involvement of the protein kinase C, PI3K/Akt, and extracellular signal-related kinase 1/2 pathways. 23 The safety and efficacy of DEX in perioperative cardiac surgery have been confirmed.…”

Section: Discussionmentioning

confidence: 99%

Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Zhou

Ling

et al. 2019

J Int Med Res

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Objective This study was performed to determine the effect of dexmedetomidine (DEX) administration on myocardial damage in cardiac surgery with sevoflurane postconditioning. Methods We retrospectively examined all cardiac valve replacement surgeries from 1 April 2016 to 30 April 2017. Eligible patients were divided into two groups based on whether DEX was infused. DEX infusion was permitted only between intubation and the beginning of cardiopulmonary bypass (CPB). Sevoflurane was inhaled via the standard postconditioning procedure starting at aortic declamping. The cardiac troponin I (cTnI) level was measured at different time points. The postoperative outcomes and complications were also analyzed. Results One hundred patients were included in the study (DEX group, n = 53; non-DEX group, n = 47). Increased cTnI levels were significantly correlated with the New York Heart Association classification, CPB time, and DEX use. DEX use and the CPB time were potential independent factors contributing to changes in the cTnI level. The cTnI level at 6, 12, and 24 hours postoperatively was remarkably lower in the DEX than non-DEX group by 1.14, 7.83, and 5.86 ng/mL, respectively. Conclusions DEX decreased the cTnI level after CPB when sevoflurane postconditioning was used, especially at 6, 12, and 24 hours postoperatively.

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Section: Discussionmentioning

confidence: 99%

Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Zhou

Ling

et al. 2019

J Int Med Res

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“…Volatile anaesthetics such as sevoflurane play a significant role in improving outcomes by decreasing the oxygen demand. 25 Methylprednisolone and mannitol may be used to improve brain oedema. 26 Overall, our experience revealed that unilateral EC is sufficiently safe, which is consistent with the findings of some prior reports.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

et al. 2019

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Objective Endovascular total aortic arch repair (ETAAR) via needle-based in situ fenestration (ISF) is a major challenge for anaesthesiologists because of haemodynamic instability and the risk of cerebral hypoxia. We herein summarise our experience with anaesthetic management of patients who underwent this procedure. Methods Fourteen patients who underwent ETAAR via ISF for arch pathologies involving the major supra-arch branches were included. Regional cerebral oxygen saturation was measured to monitor cerebral perfusion. Partial extracorporeal circulation (EC) support from the right common femoral vein to the right axillary artery was introduced to provide cerebral perfusion. Results During ISF, vessel rupture occurred in three patients and ventricular fibrillation occurred in one patient. The regional cerebral oxygen saturation significantly decreased during the potential risk period for cerebral ischaemia. Establishment of EC effectively prevented cerebral ischaemia. Conclusions During ETAAR, the risks of haemodynamic instability caused by the procedure and vessel rupture during ISF need to be overcome. Partial EC ensured good cerebral protection in our study, and regional cerebral oxygen saturation monitoring may help to reduce the rate of desaturation.

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“…1 reduction in mortality led to an increase in their use during CPB, since their cardioprotective properties might be related to the administration modalities. [2][3][4][5] Other benefits of using this technique are the reduction of CPB-induced inflammatory response, of the systemic vascular resistance and the improvement in cerebral oxygen saturation. [6][7][8] The use of VAA during CPB requires special precautions like connecting exhaust systems to the oxygenator's gas outlet port, which are mandatory to prevent operating room (OR) pollution.…”

Section: Introductionmentioning

confidence: 99%

Development of a prototype anti-pollution filter for volatile anesthetics

et al. 2020

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Introduction: The use of volatile agents during cardiopulmonary bypass allows a “single drug anesthesia” and is associated with reduced peak postoperative troponin levels. Connecting the exhaust systems to the oxygenator’s gas outlet port is mandatory and allows to prevent operating room (but not atmospheric) pollution by volatile agents. The aim of this study was to create a prototype filter for volatile agents and to test its adsorption efficacy during an ex-vivo simulated conventional cardiopulmonary bypass test. Methods: We carried out bench tests to conceive a prototype filter that could prevent room and environment pollution without damaging membrane oxygenators. We performed the tests at the Engineering Center for Circulatory Assistance Laboratory, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. Bench tests included simulation of integral adsorption tests, filter dimensions and design, flow versus pressure curve, sizing, and tightness. Results: Calgon AT 410 was the best kind of activated charcoal granules for adsorption of sevoflurane, isoflurane, and desflurane. Filter dimension tests showed that a chamber of 30-cm width over 10-cm diameter filled with 200 g of the Calgon AT410 granules was the minimum required to fully adsorb sevoflurane for 90 min. Adsorption tests showed that the prototype filter fully adsorbed isoflurane in 100 ± 2.3 min, sevoflurane in 95 ± 3.4 min, and desflurane in 95 ± 4.3 min. Conclusion: The new version of our prototype filter adsorbed most of the volatile anesthetics agents during an ex-vivo simulated conventional cardiopulmonary bypass test.

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Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Abstract: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Cited by 25 publications

References 33 publications

Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

Development of a prototype anti-pollution filter for volatile anesthetics

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