Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 4 , Pages 477-483, August 2006

Myocardial Damage Prevented by Volatile Anesthetics: A Multicenter Randomized Controlled Study

  • Fabio Guarracino, MD

      Affiliations

    • Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Azienda Ospedaliera Universitaria Pisana, Cisanello Hospital, Pisa, Italy
    • ,
  • Giovanni Landoni, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • Corresponding Author InformationAddress reprint requests to Giovanni Landoni, MD, Istituto Scientifico San Raffaele, Milano, Italia, via Olgettina 60, Milan 20132, Italy.
    • ,
  • Luigi Tritapepe, MD

      Affiliations

    • Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università degli Studi “La Sapienza,” Rome, Italy
    • ,
  • Francesca Pompei, MD

      Affiliations

    • Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università degli Studi “La Sapienza,” Rome, Italy
    • ,
  • Albino Leoni, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • ,
  • Giacomo Aletti, PhD

      Affiliations

    • Department of Mathematics, University of Milan, Milan, Italy.
    • ,
  • Anna Mara Scandroglio, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • ,
  • Daniele Maselli, MD

      Affiliations

    • Cardiothoracic Anesthesia and ICU and Cardiac Surgery, Azienda Ospedaliera Universitaria Pisana, Cisanello Hospital, Pisa, Italy
    • ,
  • Monica De Luca, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • ,
  • Chiara Marchetti, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • ,
  • Giuseppe Crescenzi, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy
    • ,
  • Alberto Zangrillo, MD

      Affiliations

    • Department of Cardiothoracic and Vascular Anesthesia, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy

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.

Key words:  volatile anesthetics , off-pump , troponin , coronary artery bypass grafting , cardiac anesthesia , cardiac biomarker , preconditioning

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 Desflurane (Suprane) was provided free of charge by the producer (Baxter).

PII: S1053-0770(06)00231-X

doi:10.1053/j.jvca.2006.05.012

Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 4 , Pages 477-483, August 2006

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