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Isoflurane preconditioning-induced cardio-protection in patients undergoing coronary artery bypass grafting

Published online by Cambridge University Press:  01 March 2006

M.-C. Lee ,
C.-H. Chen ,
M.-C. Kuo ,
P.-L. Kang ,
A. Lo  and
K. Liu
M.-C. Lee
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
C.-H. Chen
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan Kaohsiung Veterans General Hospital, Department of Cardiovascular Surgery, Kaohsiung, Taiwan
M.-C. Kuo
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
P.-L. Kang
Affiliation:
Chang Gung University, Graduate Institute of Clinical Medical Sciences, Taoyuan, Taiwan
A. Lo
Affiliation:
Chang Gung University, Graduate Institute of Clinical Medical Sciences, Taoyuan, Taiwan
K. Liu
Affiliation:
Kaohsiung Veterans General Hospital, Department of Anesthesiology, Taiwan
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Abstract

Summary

Background and objectives: Ischaemic preconditioning is commonly regarded as one of the most powerful protective mechanisms against a subsequent lethal ischaemic injury during coronary artery bypass graft surgery but is not practiced routinely. Experimentally, isoflurane, a commonly used volatile anaesthetic agent, provides myocardial protection through a signal transduction cascade that is remarkably similar to the pathways identified in ischaemic preconditioning. The aim of our study was to investigate whether pre-ischaemic administration of isoflurane exerted protection against prolonged ischaemia with functional recovery and reduced necrosis among patients undergoing coronary artery bypass graft surgery. Methods: Forty patients scheduled for elective coronary artery bypass graft operations were prospectively randomized into the control or isoflurane groups. In the isoflurane group, isoflurane 2.5 minimum alveolar concentration was administered for 15 min followed by a 5-min washout period before aortic cross-clamping. The control group received a time-matched period of isoflurane-free cardiopulmonary bypass. The conduction of anaesthesia and surgery were standardized in all patients. Haemodynamic data, troponin I release and inotropic support were measured and recorded perioperatively. Results: There were no adverse effects related to isoflurane administration. In the isoflurane group, the mean cardiac index after cardiopulmonary bypass was significantly higher than the pre-bypass value (P < 0.05), whereas no difference was found in the control group. At 15 min after cardiopulmonary bypass and 6 h after surgery, the changes in cardiac index and stroke volume index were significantly higher in the isoflurane group than in the control group (P < 0.05). There was a consistently lower release of troponin I in the isoflurane group compared to the control group. Compared to the controls, the mean troponin I level was significantly reduced in the isoflurane group at 24 h after surgery (P = 0.042). Conclusions: The present results support the preconditioning effect of isoflurane in patients undergoing coronary artery bypass graft surgery as clinically feasible and providing optimal cardiac protection.

Keywords

ISCHAEMIC PRECONDITIONING, myocardialANAESTHETICS, INHALATIONAL, isofluraneCARDIOPULMONARY BYPASS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 10 , October 2006 , pp. 841 - 847
Copyright
2006 European Society of Anaesthesiology

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