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 (original) (raw)
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Anesthesiology and Pain Medicine, 2016
Background: Major surgeries such as open-heart surgery with cardiopulmonary bypass are associated with a complexity of stress response leading to post-operative complications. Studies have confirmed that anesthesia can mitigate the surgically induced stress response. Objectives: The aim of this study was to compare the effects of propofol and isoflurane, both supplemented with Sufentanil, on the stress response in coronary artery bypass graft surgery with cardiopulmonary bypass, using cortisol as a biochemical marker. Methods: This double-blind randomized clinical trial was conducted on 72 patients who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion criteria. The subjects were randomly divided into two groups of isoflurane (n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum cortisol levels were measured and compared between the groups; 30 minutes before the surgery (T0), at the end of the cardiopulmonary bypass (T1), and 24 hours after the surgery (T2). Results: Compared to the baseline (T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma cortisol levels with no statistical significant difference (P = 0.4). At T2 measuring time point, the level of plasma cortisol significantly increased in both groups (P = 0.02), however this increase was less in the Isoflurane group. Conclusions: In CABG with cardiopulmonary bypass, using plasma cortisol level as a measure, Isoflurane-Sufentanil significantly reduces the stress response to the surgery, when compared to propofol-Sufentanil.
Journal of Cardiothoracic and Vascular Anesthesia, 2005
The purpose of this study was to compare the hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia during coronary artery bypass surgery. Design: Prospective study. Setting: University hospital. Participants: Sixty patients undergoing elective coronary artery bypass grafting surgery with ejection fraction more than 45%. Interventions: Anesthesia was induced with etomidate, 0.2 mg/kg, and fentanyl, 5 g/kg, in group D (n ؍ 30) and with midazolam, 0.1 to 0.3 mg/kg, and fentanyl, 5 g/kg, in group M (n ؍ 30). Anesthesia was maintained with desflurane, 2% to 6%, and fentanyl, 15 to 25 g/kg, in group D and midazolam infusion, 0.1 to 0.5 mg/kg/h, and fentanyl, 15 to 25 g/kg, in group M. Measurements and Main Results: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery cath-eter, and a pulmonary artery catheter. Data were obtained before induction of anesthesia (t 0), after induction of anesthesia (t 1), after intubation (t 2), after surgical incision (t 3), after sternotomy (t 4), before cardiopulmonary bypass (t 5), after protamine infusion (t 6), and at the end of the surgery (t 7). Blood samples were obtained to measure total bilirubin, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, creatinine, and blood urea nitrogen just before induction of anesthesia and at the first, fourth, and 14th days postoperatively. Conclusions: Intraoperative hemodynamic responses were similar in both groups, and transient hepatic and renal dysfunctions were observed in the postoperative period in both groups. The extubation and intensive care unit discharge times were found to be shorter in the desflurane-fentanyl group.
World Journal of Cardiovascular Surgery, 2012
To compare the effects of propofol and etomidate induction on hemodynamic parameters and serum cortisol levels in patients with normal left ventricular function undergoing elective coronary artery bypass graft surgery on cardiopulmonary bypass. Material and Method: After approval from the Institute Ethics committee hundred American Society of Anesthesiologists (ASA) grade II or III patients undergoing scheduled coronary artery bypass surgery on cardiopulmonary bypass were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for anesthesia induction. Anesthesia was maintained in both groups with sevoflurane, vecuronium bromide for muscle relaxation (0.1 mg/kg, boluses) and fentanyl up to a total dose of 20 mcg/kg. Result: The baseline serum cortisol values were within normal limits in both the groups. The serum cortisol levels in the propofol group increased more than two fold, whereas the values in the etomidate group decreased by close to fifty percent on weaning from cardiopulmonary bypass (CPB). There was no significant difference in serum cortisol levels in the two groups at twenty-four hours after induction, although the values were close to double the baseline levels. Hemodynamically, etomidate group was more stable than propofol group following induction of anesthesia (P < 0.05). Conclusion: The surge in serum cortisol levels on the initiation of CPB seen after the use of propofol is prevented by the use of etomidate. Serum cortisol levels in both groups are well above the baseline at twenty-four hours without any untoward effects. Etomidate provides more stable hemodynamic parameters when used for induction of anesthesia as compared to propofol.
Factors influencing preoperative stress response in coronary artery bypass graft patients
BMC anesthesiology, 2004
BACKGROUND: In many studies investigating measures to attenuate the hemodynamic and humoral stress response during induction of anaesthesia, primary attention was paid to the period of endotracheal intubation since it has been shown that even short-lasting sympathetic cardiovascular stimulation may have detrimental effects on patients with coronary artery disease. The aim of this analysis was, however, to identify the influencing factors on high catecholamine levels before induction of anaesthesia. METHODS: Various potential risk factors that could impact the humoral stress response before induction of anaesthesia were recorded in 84 males undergoing coronary aortic bypass surgery, and were entered into a stepwise linear regression analysis. The plasma level of norepinephrine measured immediately after radial artery canulation was chosen as a surrogate marker for the humoral stress response, and it was used as the dependent variable in the regression model. Accordingly, the mean art...
BJA: British Journal of Anaesthesia, 1987
Although the efficacy of propofol-as an induction agent-has been studied in patients with coronary artery disease (Patrick et al., 1985), the haemodynamic effects of a maintenance technique, in which propofol was infused continuously in patients about to undergo elective coronary bypass surgery, have not been reported. This study describes the haemodynamic effects associated with induction of anaesthesia using propofol, and the continuous infusion of propofol (supplemented with fentanyl) during the pre-bypass period. PATIENTS AND METHODS The design of the study was approved by the Ethical Committee of the Antwerp University Hospital. Fifteen patients with good left ventricular function (ejection fraction > 55 % and left ventricular end diastolic pressure < 14 mm Hg), scheduled for elective coronary bypass surgery were included in the study. Mean age was 53 ± 9 (SD) yr, average weight 75.6+11.2 kg and mean body surface area was 1.87 ±0.17 m 2. All patients had angiographically proven coronary artery disease (two-or three-vessel disease); no patient had significant left main coronary artery stenosis. Thirteen patients were taking beta-adrenoreceptor antagonists. Five patients had a history of previous infarction, and four other patients had
2021
Introduction: Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is assumed that propofol, a general anesthetic agent, has a protective role against oxidative stress. The aim of this study was to evaluate the effect of propofol on myocardial protection when added to cardioplegic solution in patients undergoing CABG. Methods: In this prospective and double-blind RCT study, 120 patients undergoing CABG surgery were randomly assigned into two equal groups. In one group, we added 1200 µg/min (ultimate dose 4 µg/ml) propofol to cardioplegic solution and in the control group, an equal volume of normal saline was added to cardioplegic solution. Serum levels of CPK-MB and Troponin I were checked at four time points, including: just after induction (T1) as baseline, after chest closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU admission (T4). ...
Annals of Cardiac Anaesthesia, 2013
Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA) with propofol in offpump coronary artery bypass surgery (OPCAB) by measuring cardiac troponin-T (cTnT) as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.
European Journal of Cardio-Thoracic Surgery, 2007
Background: Recent clinical and experimental data indicate that volatile anaesthetics may precondition myocardium against ischaemia and infarction. The present clinical trial was designed to verify the cardioprotective effects of desflurane in patients undergoing elective coronary artery bypass surgery. It was hypothesized that desflurane preconditioning would decrease postoperative release of troponin I and brain natriuretic peptide (NT-proBNP). Besides, we have hypothesized that desflurane preconditioning would preserve the myocardium from the dysfunction following cardioplegic arrest. Methods: Twenty-eight patients were randomly divided into two groups: Control group (14 patients) and Desflurane group (14 patients). In Desflurane group (DS) patients, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-min exposure to desflurane (2.5 minimum alveolar concentration), followed by a 10-min washout before aortic cross-clamping and cardioplegic arrest. The control group (C) patients underwent an equivalent period (15 min) of pre-arrest desflurane-free bypass. Haemodynamic measurements were obtained at six different times. The biochemistry markers of cellular damage and myocardial dysfunction (troponin I, NT-proBNP) were determined. Left ventricular (LV) function was assessed using tissue Doppler imaging (TDI) of mitral annulus. Two-factor repeated-measures analysis of variance was used to evaluate differences over time between groups for all parameters determined in plasma samples and for all TDI-derived variables. Results: After surgery, both the troponin I values (2.04 AE 1.09 ng/ml vs 1.44 AE 0.77 ng/ml, p < 0.01 after 24 h and 1.62 AE 0.96 ng/ml vs 1.00 AE 0.24 ng/ml, p < 0.01 after 72 h respectively) and those of the NT-proBNP (2187 AE 282.9 ng/l vs 885.4 AE 117.35 ng/l, p < 0.01 after 24 h and 3097.9 AE 226.2 vs 1393.6 AE 312.07 ng/l, p < 0.01 after 72 h respectively) were less in the desflurane-treated patients. The values of TDI of mitral annulus were constantly better in desflurane-treated patients. Conclusions: We can conclude that the use of desflurane in these patients provides a pharmacological preconditioning so as to reduce myocardial necrosis and improve the cardiac performance in the postoperative period.