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KMID : 1155520120070040320
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Anesthesia and Pain Medicine
2012 Volume.7 No. 4 p.320 ~ p.324
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Comparison of cardioprotection between sevoflurane-remifentanil and midazolam- sufentanil total intravenous anesthesia during off-pump coronary artery bypass surgery
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Gil Nam-Su
Shon Yoon-Jung
Hwang Jin-Young
Choi Seung-Pyo
Shim Sung-Eun
Huh Jin
Min Seong-Won
Kim Chong-Soo
Jeon Yun-Seok
Lee Sue-Young
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Abstract
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Background:Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review. Methods:The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68), and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical, anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured. Results:All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover, there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1?5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009), 3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485 ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively). Conclusions:Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG. (Anesth Pain Med 2012; 7: 320∼324)
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KEYWORD
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Cardiac anesthesia, Myocardial protection, Preconditioning, Sevoflurane
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