Objective
Several studies have suggested that the cardioprotective effects of halogenated anesthetics
in cardiac surgery result in reduced cardiac biomarker release compared with total
intravenous anesthesia (TIVA). These findings came from relatively small randomized
clinical trials and meta-analyses. The authors of this study hypothesized that the
beneficial effects of volatile anesthetics translate into a reduced length of hospital
stay after coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass.
Design
A randomized controlled trial.
Setting
Two university hospitals.
Participants
Adult patients undergoing elective CABG surgery with cardiopulmonary bypass.
Interventions
Patients were assigned randomly to 2 following groups: propofol-based TIVA group (n
= 431) and sevoflurane group (n = 437).
Measurements and Main Results
The primary endpoint was hospital length of stay, and the secondary endpoint included
postoperative troponin T and N-terminal pro-brain natriuretic peptide release and
mortality. In the sevoflurane group, a reduced length of hospital stay was observed
compared with the propofol-based TIVA group (10 [9–11] days v 14 [10–16], p<0.001) as were reductions in cardiac troponin T release (0.18 ng/mL
v 0.57 ng/mL at 24 hours, p<0.001), in N-terminal pro-brain natriuretic peptide release
(633 pg/mL v 878 pg/mL at 24 hours, p<0.001; 482 pg/mL v 1,036 pg/mL at 48 hours, p<0.001), and in mortality at 1-year follow up (17.8% v 24.8%, p = 0.03).
Conclusions
Anesthesia with sevoflurane reduced cardiac biomarker release and length of hospital
stay after CABG with cardiopulmonary bypass surgery compared with propofol-based TIVA
with a possible reduction in 1-year mortality.
Key Words
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Article info
Publication history
Published online: July 15, 2016
Footnotes
G. L. acknowledges receiving modest speaker fees from AbbVie, Chicago, IL.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
