Feasibility of Anesthesia Maintenance With Sevoflurane During Cardiopulmonary Bypass: A Pilot Pharmacokinetics Study (original) (raw)
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Anesthesia & Analgesia, 2006
Background: Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration.
European Journal of Anaesthesiology, 2012
Context Volatile anaesthetics may have direct cardioprotective properties due to effects similar to ischaemic preconditioning and postconditioning. Clinical results in cardiac surgery patients are controversial and may be related to the timing of administration of anaesthetics intraoperatively. Objective We hypothesised that the cardioprotective effect of sevoflurane in coronary bypass graft surgical patients would be greater if administration during anaesthesia continued in the ICU for at least 4 h postoperatively until weaning from mechanical ventilation. Design Double-blind, double-dummy, prospective, randomised and controlled clinical trial. Setting In a single centre between June 2006 and June 2007. Patients Seventy-five adult patients were assigned randomly to receive anaesthesia and postoperative sedation either with propofol (control, n ¼ 37) or sevoflurane (n ¼ 36). Interventions Myocardial biomarkers were measured before surgery, at the time of admission to the intensive care unit and at 6, 24, 48 and 72 h. The need for inotropic support, and lengths of stay in the intensive care unit and hospital were also recorded. Main outcome measures Elevation of myocardial biomarkers was the primary endpoint. The secondary endpoints were haemodynamic events and lengths of stay in the intensive care unit and hospital. Results Necrosis biomarkers increased significantly in the postoperative period in both groups with no significant differences at any time. Inotropic support was needed in 72.7 and 54.3% of patients in the propofol and sevoflurane groups, respectively (P ¼ 0.086). There were no significant differences in haemodynamic variables, incidence of arrhythmias, myocardial ischaemia or and lengths of stay in the ICU and hospital between the two groups. Conclusion In patients undergoing coronary bypass graft surgery, continuous administration of sevoflurane as a sedative in the ICU for at least 4 h postoperatively did not yield significant improvements in the extent and time course of myocardial damage biomarkers compared to propofol.
Comparison of Isoflurane and Sevoflurane in Cardiac Surgery
Survey of Anesthesiology, 2017
Purpose Volatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was noninferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery. Methods This was a pragmatic randomized noninferiority comparative effectiveness clinical trial in 464 adults having coronary artery bypass graft and/or single valve surgery during November 2011 to March 2014. The intervention was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n = 233) administered at a dose of 0.5-2.0 MAC throughout the entire operation. All caregivers were blinded except for the anesthesiologist and perfusionist. The primary outcome was a composite of intensive care unit (ICU) length of stay C 48 hr and all-cause 30-day mortality. We hypothesized that sevoflurane would be non-inferior to isoflurane (noninferiority margin \ 10% based on an expected event rate of 25%). Secondary outcomes included prolonged ICU stay, 30-and 365-day all-cause mortality, inotrope or vasopressor usage, new-onset hemodialysis or atrial fibrillation, stroke, and readmission to the ICU. Results No losses to follow-up occurred. The primary outcome occurred in 25% of sevoflurane patients and 30% of isoflurane patients (absolute difference,-5.4%; onesided 95% confidence interval, 1.4), thus non-inferiority was declared. Sevoflurane was not superior to isoflurane for the primary outcome (P = 0.21) or for any secondary outcomes. Conclusion Sevoflurane is non-inferior to isoflurane on a composite outcome of prolonged ICU stay and all-cause This article is accompanied by an editorial. Please see Can J Anesth 2016; 63: this issue.
British Journal of Anaesthesia, 2007
Background. Volatile agents can mimic ischaemic preconditioning leading to a decrease in myocardial infarct size. The present study investigated if a 15 min sevoflurane administration before cardiopulmonary bypass (CPB) has a cardioprotective effect in patients undergoing coronary surgery. Methods. Seventy-two patients were randomized in two centres. The intervention group (S) received 1 MAC sevoflurane administrated via the ventilator for 15 min followed by a 15 min washout before CPB, the control group did not. The primary outcome was the postoperative troponin Ic peak. A biopsy of the atrium was taken during canulation for enzyme dosages. Results are expressed as mean (SD). Results. Neither troponin Ic nor tissular enzyme measurement exhibited any difference between the groups: peak of troponin Ic was 4.4 (5.6) in S group vs 5.2 (6.6) ng ml 21 in control group (ns). Intratissular ecto-5 0-nucleotidase activity was 7.1 (4.3) vs 8.5 (11.9), protein kinase C activity was 27.1 (15.7) vs 29.2 (28.7), tyrosine kinase activity was 101 (54.1) vs 98.5 (63.3), and P38 MAPKinase activity was 131.1 (76.1) vs 127.1 (86.8) nmol mg protein 21 min 21 in S group and control group, respectively (ns). However there were fewer patients with low postoperative cardiac index in S group (11% in S vs 35% in control group, P,0.05) when considering the per protocol population. In S group, 25% of patients required an inotropic support during the postoperative period, vs 36% of patients in control group (ns). Conclusions. This study did not show a significant preconditioning signal after 15 min of sevoflurane administration. The 15 min duration might be too short or the concentration of sevoflurane too low to induce cardioprotection detected by troponin I levels.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2016
Volatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was non-inferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery. This was a pragmatic randomized non-inferiority comparative effectiveness clinical trial in 464 adults having coronary artery bypass graft and/or single valve surgery during November 2011 to March 2014. The intervention was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n = 233) administered at a dose of 0.5-2.0 MAC throughout the entire operation. All caregivers were blinded except for the anesthesiologist and perf...
Background: Volatile anesthetics like sevoflurane and desflurane have been used in various cardiac surgeries with a purpose of myocardial protection, renal protection, and early extubation. Maintaining hemodynamics during off pump coronary artery bypass grafting (OPCABG) is challenging for cardiac anesthesiologists. We compared desflurane and sevoflurane in patients undergoing OPCABG. Methods: A sample size of 148 patients were randomly allocated into two groups after permission from the institutional ethical committee and review board with written and informed consent from each patient. Patients with ASA grade 3 and 4 between the age group 30-60 yrs of either sex, having ejection fraction (EF) >40% undergoing coronary artery bypass grafting under general anesthesia were included in the study. Patients with anticipated difficult intubation, compromised renal and pulmonary function, hypersensitive to drugs used in the study, with altered coagulation profile, diabetes mellitus, obesity, left ventricular ejection fraction <40%, with severe cardiac arrhythmias were excluded from the study. Anesth Crit Care 2020; 2 (2): 025-038 Anesthesia and Critical Care 26 Results: The primary outcomes included the heart rate, mean arterial pressure, cardiac output, cardiac index, and systemic vascular resistance from baseline 15, 30, 45 and 60 minutes after intubation and 1 hour after surgery. The secondary outcomes included CPK-MB, blood urea, and serum Creatinine and any other side effect 24 hrs postoperatively. There was an increase in the heart rate just after induction and 15 minutes post intubation in the sevoflurane group as compared to the desflurane group with a p value of 0.0001 and 0, 0006 which is statistically significant. There was a statistically significant decrease in the mean arterial blood pressure in the desflurane group with a p value of 0.0001 and 0.001. Cardiac output increased in the desflurane group 30, 45 and 60 minutes after intubation with a p value of 0.04, 0.008 and 0.006 which was statistically significant. Systemic vascular resistance also decreased in the desflurane group with a p value of 0.019 and 0.011. But sevoflurane showed decreased CPK-MB levels 46.61 ± 21.90 S.D as compared to 50.49 ± 26.29 S.D in the desflurane after 24 hrs postoperstively which was not statistically significant. Blood urea and serum Creatinine were also elevated in the desflurane group. Conclusion: During the crucial period of off pump coronary artery bypass grafting the maintenance of hemodynamic stability was better seen with desflurane as compared to sevoflurane and is suggested to be used for better outcome of patients.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac surgery. These complications are thought to be caused by embolisms and cerebral hypoxia. Thus, continuous neuromonitoring is essential during cardiac surgery due to cerebral oxygen desaturation during different periods. Near-infrared spectrophotometry (NIRS), a non-invasive method, appears to offer many advantages for monitoring cerebral oxygenation and hemodynamics. Desaturation of cerebral oxygen may occur at the beginning of cardiopulmonary bypass (CPB) or during the low perfusion and rewarming stages if not corrected. This study was designed to assess the effects of sevoflurane on cerebral protection during CPB. Eighty patients were divided into two groups. Anesthesia was maintained either with fentanyl and midazolam (total intravenous anesthesia, TIVA) or with one minimum alveolar concentration of sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute...
Sevoflurane pharmacokinetics: effect of cardiac output
British Journal of Anaesthesia, 1998
Sevoflurane uptake (V sevo) can be predicted by the square root of time model or the fourcompartment model. However, V sevo and the effect of cardiac output on anaesthetic uptake have not been quantified clinically. After obtaining IRB approval and informed consent, 34 adult patients received closed-circuit anaesthesia with sevoflurane for 1 h. The end-expired sevoflurane concentration was maintained at 2.6% by infusion of liquid sevoflurane into the breathing system. In a subgroup of 12 patients, cardiac output was measured every 5 min by thermodilution (CO group). The effect of patient characteristics (age, height, weight, body surface area) and cardiac output on V sevo were determined, and V sevo was compared with the theoretical models. In the CO group, measured cardiac output was used in the formulae of these models. A two-exponential curve described average V sevo well: V sevo (ml liquid) :0;1.62 (1-e 92.3 t);18.1 (1-e 90.0089 t), r 2 90.999. There was no correlation between V sevo and patient characteristics, except that V sevo was greater in patients with a greater cardiac output (r 2 :0.36) and cardiac index (r 2 :0.35). The rate of sevoflurane uptake decreased less than predicted by the square root of time and four-compartment models, even when measured cardiac output was used in the formulae. These findings confirm that the square root of time and four-compartment models do not accurately predict anaesthetic uptake. In addition, uptake of sevoflurane cannot be predicted by patient characteristics but was higher in patients with a higher cardiac output. (Br.