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Cardiac protection by volatile anaesthetics: a multicentre randomized controlled study in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Published online by Cambridge University Press:  01 April 2007

L. Tritapepe ,
G. Landoni ,
F. Guarracino ,
F. Pompei ,
M. Crivellari ,
D. Maselli ,
M. De Luca ,
O. Fochi ,
S. D’Avolio  and
E. Bignami
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L. Tritapepe
Affiliation:
Università degli Studi ‘La Sapienza’ di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy
G. Landoni
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
F. Guarracino
Affiliation:
Azienda OspedalieraUniversitaria Pisana, Cisanello Hospital, Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Pisa, Italy
F. Pompei
Affiliation:
Università degli Studi ‘La Sapienza’ di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy
M. Crivellari
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
D. Maselli
Affiliation:
Azienda OspedalieraUniversitaria Pisana, Cisanello Hospital, Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Pisa, Italy
M. De Luca
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
O. Fochi
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
S. D’Avolio
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
E. Bignami
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
M. G. Calabrò
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
A. Zangrillo
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Department of Cardiothoracic and Vascular Anestesia, Milano, Italia, Pisa, Italy
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Summary

Background and objectives

To evaluate the effects of total intravenous anaesthesia vs. volatile anaesthesia on cardiac troponin release in coronary artery bypass grafting with cardiopulmonary bypass, we performed a multicentre randomized controlled study to compare postoperative cardiac troponin release in patients receiving two different anaesthesia plans.

Methods

We randomly assigned 75 patients to propofol (intravenous anaesthetic) and 75 patients to desflurane (volatile anaesthetic) in addition to an opiate-based anaesthesia for coronary artery bypass grafting. Peak postoperative troponin I release was measured as a marker of myocardial necrosis.

Results

There was a significant (P < 0.001) difference in the postoperative median (25th–75th percentiles) peak of troponin I in patients receiving propofol 5,5 (2,3–9,5) ng dL−1 when compared to patients receiving desflurane 2,5 (1,1–5,3) ng dL−1. The median (interquartile) troponin I area under the curve analysis confirmed the results: 68 (30.5–104.8) vs. 36.3 (17.9–86.6) h ng dL−1 (P = 0.002). Patients receiving volatile anaesthetics had reduced need for postoperative inotropic support (24/75, 32.0% vs. 31/75, 41.3%, P = 0.04), and tends toward a reduction in number of Q-wave myocardial infarction, time on mechanical ventilation, intensive care unit and overall hospital stay.

Conclusions

Myocardial damage measured by cardiac troponin release could be reduced by volatile anaesthetics in coronary artery bypass surgery.

Keywords

INHALATION ANAESTHETICSCARDIOPULMONARY BYPASSTROPONINCORONARY ARTERY BYPASS GRAFTINGCORONARY ARTERY BYPASS SURGERY
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 323 - 331
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Selvanayagam, JB, Porto, I, Channon, K et al. . Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation 2005; 111: 1027–1032.Google Scholar
2.Steuer, J, Bjerner, T, Duvernoy, O et al. . Visualisation and quantification of peri-operative myocardial infarction after coronary artery bypass surgery with contrast-enhanced magnetic resonance imaging. Eur Heart J 2004; 25: 1293–1299.CrossRefGoogle ScholarPubMed
3.Salamonsen, RF, Schneider, HG, Bailey, M, Taylor, AJ. Cardiac troponin I concentrations, but not electrocardiographic results, predict an extended hospital stay after coronary artery bypass graft surgery. Clin Chem 2005; 51: 40–46.Google Scholar
4.Lehrke, S, Steen, H, Sievers, HH et al. . Cardiac troponin T for prediction of short- and long-term morbidity and mortality after elective open heart surgery. Clin Chem 2004; 50: 1560–1567.CrossRefGoogle Scholar
5.Kathiresan, S, Servoss, SJ, Newell, JB et al. . Cardiac troponin T elevation after coronary artery bypass grafting is associated with increased one-year mortality. Am J Cardiol 2004; 94: 879–881.Google Scholar
6.Fellahi, JL, Gue, X, Richomme, X, Monier, E, Guillou, L, Riou, B. Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology 2003; 99: 270–274.CrossRefGoogle Scholar
7.Lasocki, S, Provenchere, S, Benessiano, J et al. . Philip I. Cardiac troponin I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 2002; 97: 405–411.Google Scholar
8.Zaugg, M, Schaub, MC, Foex, P. Myocardial injury and its prevention in the perioperative setting. Br J Anaesth 2004; 93: 21–33.CrossRefGoogle ScholarPubMed
9.Kato, R, Foex, P. Myocardial protection by anesthetic agents against ischemia-reperfusion injury: an update for anesthesiologists. Can J Anaesth 2002; 49: 777–791.CrossRefGoogle ScholarPubMed
10.Riess, ML, Stowe, DF, Waltier, DC. Cardiac pharmacological preconditioning with volatile anesthetics: from bench to bedside? Am J Physiol Heart Circ Physiol 2004; 286: H1603–H1607.CrossRefGoogle ScholarPubMed
11.Cohen, G, Shirai, T, Weisel, RD et al. . Optimal myocardial preconditioning in a human model of ischemia and reperfusion. Circulation 1998; 98 (Suppl II): II-184–II-96.Google Scholar
12.De Hert, SG, Van der Linden, PJ, Cromheecke, S et al. . Choice of primary anesthetic regimen can influence intensive care unit length of stay coronary surgery with cardiopulmonary bypass. Anesthesiology 2004; 101: 9–20.Google Scholar
13.De Hert, SG, Van der Linden, PJ, Cromheecke, S et al. . Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anesthesiology 2004; 101: 299–310.Google Scholar
14.Belhomme, D, Peynet, J, Louzy, M, Launay, JM, Kitakaze, M, Menasche, P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation 1999; 100 (Suppl II): 340–344.CrossRefGoogle ScholarPubMed
15.Tomai, F, De Paulis, R, Penta de Peppo, A et al. . Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol 1999; 29: 1007–1014.Google ScholarPubMed
16.De Hert, SG, ten Broecke, PW, Mertens, E et al. . Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology 2002; 97: 42–49.CrossRefGoogle Scholar
17.Kato, R, Foex, P. Myocardial protection by anaesthetic agents against ischemiare-perfusion injury: an update for anesthesiologists. Can J Anaesth 2002; 9: 777–791.Google Scholar
18.Crescenzi, G, Cedrati, V, Landoni, G et al. . Cardiac biomarker release after CABG with different surgical techniques. J Cardiothorac Vasc Anesth 2004; 18: 34–37.Google Scholar
19.Alpert, JS, Thygesen, K, Antman, E, Bassand, JP. Myocardial infarction redefined – a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36: 959–969.Google Scholar
20.Murry, CE, Jennings, RB, Reimer, KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74: 1124–1136.Google Scholar
21.Julier, K, da Silva, R, Garcia, C et al. . Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study. Anesthesiology 2003; 98: 1315–1327.Google Scholar
22.Garcia, C, Julier, K, Bestmann, L et al. . Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery. Br J Anaesth 2005; 94: 159–165.Google Scholar