Abstract
Objective: The purpose of this study was to evaluate the effects of volatile anesthesia versus total intravenous anesthesia on cardiac troponin release in off-pump coronary artery bypass grafting (OPCAB). Design: The authors performed a multicenter randomized controlled study to compare cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for cardiac surgery on the beating heart, which is an excellent model of human myocardial ischemia. Setting: Three university hospitals. Participants: The authors randomly assigned 57 patients to desflurane (volatile anesthetic) and 55 patients to propofol (intravenous anesthetic) in addition to an opiate-based anesthesia for OPCAB. Interventions: The 2 groups of patients received either desflurane (volatile anesthetic) or propofol in addition to an opiate-based anesthesia for OPCAB. Peak postoperative troponin I release was measured as a marker of myocardial necrosis. Prolonged hospitalization was considered as a secondary outcome. Measurements and Main Results: Patient mean age was 69 years, and 82% were men. There was a significant (p <0.001) reduction in postoperative median (25th-75th percentiles) peak of troponin I in patients receiving volatile anesthetics, 1.2 (0.9-1.9) ng/dL, compared with patients receiving total intravenous anesthesia, 2.7 (2.1-4.0) ng/dL. This myocardial protection resulted in a reduced (p = 0.04) number (percentage) of patients requiring postoperative inotropes, 20 (35%) versus 31 (56%), and a reduced number (percentage) of patients submitted to prolonged hospitalization (≥7 days), 7 (12%) versus 20 (36%) in the 2 groups (p = 0.005). One patient receiving total intravenous anesthesia died within 30 days of surgery. Conclusions: Myocardial damage measured by cardiac troponin release could be reduced by volatile anesthetics during OPCAB. Because patients underwent cardiac surgery on the beating heart, these results could have implications for cardiac patients undergoing noncardiac surgery.
| Original language | English |
|---|---|
| Pages (from-to) | 477-483 |
| Number of pages | 7 |
| Journal | Journal of Cardiothoracic and Vascular Anesthesia |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Aug 2006 |
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Keywords
- cardiac anesthesia
- cardiac biomarker
- coronary artery bypass grafting
- off-pump
- preconditioning
- troponin
- volatile anesthetics
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Myocardial Damage Prevented by Volatile Anesthetics : A Multicenter Randomized Controlled Study. / Guarracino, Fabio; Landoni, Giovanni; Tritapepe, Luigi; Pompei, Francesca; Leoni, Albino; Aletti, Giacomo; Scandroglio, Anna Mara; Maselli, Daniele; De Luca, Monica; Marchetti, Chiara; Crescenzi, Giuseppe; Zangrillo, Alberto.
In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 20, No. 4, 08.2006, p. 477-483.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Myocardial Damage Prevented by Volatile Anesthetics
T2 - A Multicenter Randomized Controlled Study
AU - Guarracino, Fabio
AU - Landoni, Giovanni
AU - Tritapepe, Luigi
AU - Pompei, Francesca
AU - Leoni, Albino
AU - Aletti, Giacomo
AU - Scandroglio, Anna Mara
AU - Maselli, Daniele
AU - De Luca, Monica
AU - Marchetti, Chiara
AU - Crescenzi, Giuseppe
AU - Zangrillo, Alberto
PY - 2006/8
Y1 - 2006/8
N2 - Objective: The purpose of this study was to evaluate the effects of volatile anesthesia versus total intravenous anesthesia on cardiac troponin release in off-pump coronary artery bypass grafting (OPCAB). Design: The authors performed a multicenter randomized controlled study to compare cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for cardiac surgery on the beating heart, which is an excellent model of human myocardial ischemia. Setting: Three university hospitals. Participants: The authors randomly assigned 57 patients to desflurane (volatile anesthetic) and 55 patients to propofol (intravenous anesthetic) in addition to an opiate-based anesthesia for OPCAB. Interventions: The 2 groups of patients received either desflurane (volatile anesthetic) or propofol in addition to an opiate-based anesthesia for OPCAB. Peak postoperative troponin I release was measured as a marker of myocardial necrosis. Prolonged hospitalization was considered as a secondary outcome. Measurements and Main Results: Patient mean age was 69 years, and 82% were men. There was a significant (p <0.001) reduction in postoperative median (25th-75th percentiles) peak of troponin I in patients receiving volatile anesthetics, 1.2 (0.9-1.9) ng/dL, compared with patients receiving total intravenous anesthesia, 2.7 (2.1-4.0) ng/dL. This myocardial protection resulted in a reduced (p = 0.04) number (percentage) of patients requiring postoperative inotropes, 20 (35%) versus 31 (56%), and a reduced number (percentage) of patients submitted to prolonged hospitalization (≥7 days), 7 (12%) versus 20 (36%) in the 2 groups (p = 0.005). One patient receiving total intravenous anesthesia died within 30 days of surgery. Conclusions: Myocardial damage measured by cardiac troponin release could be reduced by volatile anesthetics during OPCAB. Because patients underwent cardiac surgery on the beating heart, these results could have implications for cardiac patients undergoing noncardiac surgery.
AB - Objective: The purpose of this study was to evaluate the effects of volatile anesthesia versus total intravenous anesthesia on cardiac troponin release in off-pump coronary artery bypass grafting (OPCAB). Design: The authors performed a multicenter randomized controlled study to compare cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for cardiac surgery on the beating heart, which is an excellent model of human myocardial ischemia. Setting: Three university hospitals. Participants: The authors randomly assigned 57 patients to desflurane (volatile anesthetic) and 55 patients to propofol (intravenous anesthetic) in addition to an opiate-based anesthesia for OPCAB. Interventions: The 2 groups of patients received either desflurane (volatile anesthetic) or propofol in addition to an opiate-based anesthesia for OPCAB. Peak postoperative troponin I release was measured as a marker of myocardial necrosis. Prolonged hospitalization was considered as a secondary outcome. Measurements and Main Results: Patient mean age was 69 years, and 82% were men. There was a significant (p <0.001) reduction in postoperative median (25th-75th percentiles) peak of troponin I in patients receiving volatile anesthetics, 1.2 (0.9-1.9) ng/dL, compared with patients receiving total intravenous anesthesia, 2.7 (2.1-4.0) ng/dL. This myocardial protection resulted in a reduced (p = 0.04) number (percentage) of patients requiring postoperative inotropes, 20 (35%) versus 31 (56%), and a reduced number (percentage) of patients submitted to prolonged hospitalization (≥7 days), 7 (12%) versus 20 (36%) in the 2 groups (p = 0.005). One patient receiving total intravenous anesthesia died within 30 days of surgery. Conclusions: Myocardial damage measured by cardiac troponin release could be reduced by volatile anesthetics during OPCAB. Because patients underwent cardiac surgery on the beating heart, these results could have implications for cardiac patients undergoing noncardiac surgery.
KW - cardiac anesthesia
KW - cardiac biomarker
KW - coronary artery bypass grafting
KW - off-pump
KW - preconditioning
KW - troponin
KW - volatile anesthetics
UR - http://www.scopus.com/inward/record.url?scp=33746327483&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33746327483&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2006.05.012
DO - 10.1053/j.jvca.2006.05.012
M3 - Article
C2 - 16884976
AN - SCOPUS:33746327483
VL - 20
SP - 477
EP - 483
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 4
ER -