Sevoflurane-Remifentanil Versus Propofol-Remifentanil Anesthesia at a Similar Bispectral Level for Off-Pump Coronary Artery Surgery: No Evidence of Reduced Myocardial Ischemia

Objective: Sevoflurane 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.

Design: Prospective, randomized single-blind clinical study.

Setting: University hospital.

Participants: Eighteen patients.

Interventions: General 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 Results: Groups 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).

Conclusion: This 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.

Key words:  off-pump coronary bypass surgery , ischemia , volatile , sevoflurane , intravenous , propofol , monitoring , bispectral index