• J. Cardiothorac. Vasc. Anesth. · Aug 2006

    Randomized Controlled Trial Comparative Study

    Sevoflurane-remifentanil versus propofol-remifentanil anesthesia at a similar bispectral level for off-pump coronary artery surgery: no evidence of reduced myocardial ischemia.

    • Jean Dominique Law-Koune, Catherine Raynaud, Ngai Liu, Claude Dubois, Mauro Romano, and Marc Fischler.
    • Department of Anesthesiology, Foch Hospital, Suresnes, France.
    • J. Cardiothorac. Vasc. Anesth. 2006 Aug 1;20(4):484-92.

    ObjectiveSevoflurane could decrease myocardial ischemic injury in patients undergoing off-pump coronary artery bypass surgery. This study was designed to compare postoperative troponin I (cTnI) concentrations after sevoflurane-remifentanil versus propofol-remifentanil anesthesia.DesignProspective, randomized single-blind clinical study.SettingUniversity hospital.ParticipantsEighteen patients.InterventionsGeneral anesthesia was conducted with sevoflurane-remifentanil (n = 9) or propofol-remifentanil (n = 9). Administration of sevoflurane and propofol was adjusted to maintain the bispectral index (BIS) between 40 and 60.Measurements And Main ResultsGroups were comparable regarding the patients' characteristics. The objective of BIS was maintained in both groups except during the period of coronary artery grafts (p < 0.001) when the BIS number in the propofol group fell below 40 and was significantly lower than in the sevoflurane group. Intraoperative hemodynamic variables were similar between groups. No patient required cardiopulmonary bypass. Need for inotropic and vasoactive support during the first graft was not necessary in the propofol group and occurred in 4 patients in the sevoflurane group (not significant). During the second graft, 2 patients in the propofol group and 3 in the sevoflurane group needed hemodynamic support. Postoperative hemodynamic variables were comparable between groups. Areas under the curve of postoperative increases in cTnI were 27.0 +/- 38.6 and 17.4 +/- 14.6 ng/mL/hour in the sevoflurane and propofol groups, respectively (not significant).ConclusionThis study does not support cardioprotective effects of sevoflurane. The particularly short total cumulative duration of ischemia and the relatively low administered end-tidal sevoflurane concentrations may explain this result.

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