• Serge K Ndoko, Loïc Tual, Bouziane Ait Mamar, Stéphane Sauvat, Patricia Jabre, Mohamed Zakhouri, Odile Rosanval, Moustapha Abdi, Matthias Kirsch, Bruno Pouzet, Daniel Loisance, and Gilles Dhonneur.
• Department of Anesthesiology and Surgical Intensive Care, Paris XII, University Hospital Henri Mondor, Créteil, France. serge.ndoko@jvr.aphp.fr
• J. Cardiothorac. Vasc. Anesth. 2007 Oct 1;21(5):683-9.

ObjectiveCardioprotective properties have been shown with halogenated volatile agents. It was hypothesized that low-dose isoflurane administered before aortic cross-clamping may reduce the amount of dobutamine required to improve impaired postoperative cardiac function after various types of cardiac surgery.DesignA prospective, randomized trial.SettingAn anesthesia and intensive care unit, university hospital.ParticipantsTwo hundred eighty cardiac surgery patients.InterventionsAll patients allocated to either isoflurane treatment (T) or no treatment (control group [C]) received total intravenous anesthesia. In the treatment group, isoflurane was administered at a 0.5 minimum alveolar concentration (MAC) from tracheal intubation to initiation of cardiopulmonary bypass (CPB). During weaning from CPB, dobutamine was introduced by using a hemodynamically driven decision tree.Measurements And Main ResultsThe number of patients receiving dobutamine was comparable (66 v 78, p = 0.07, in T and C groups, respectively). The total amount of postoperative dobutamine indexed to patient weight, considered as the primary endpoint, was reduced in the isoflurane-treated group (4.2 +/- 8 v 7.2 +/- 15, p < 0.02, in T and C, respectively). Isoflurane was identified as an independent variable significantly (odds ratio [confidence interval]) influencing the total amount of postoperative dobutamine (0.53 [0.31-0.92], p < 0.02). Postoperative troponin I release at 20 hours was not affected by isoflurane treatment.ConclusionsThis study revealed that exposure to 0.5 MAC isoflurane before CPB reduced the total amount of dobutamine required to normalize postoperative cardiac dysfunction in various types of cardiac surgical patients.

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