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Cardioprotective efficacy of sevoflurane vs. propofol during induction and/or maintenance in patients undergoing coronary artery revascularization surgery without pump: A randomized trial.

Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain; Instituto de Investigaciones Biomédicas de Málaga (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: guerreroorriach@terra.es. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: mgalanortega@yahoo.es. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: aliramfdez@hotmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: Martaram85@hotmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: mimorenocortes@hotmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: danielarizavillanueva@gmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: anaisfv@hotmail.com. CIBER Unidad de Gestión Clínica de Endocrinología y Nutrición, Málaga, Spain. Department of Anesthesia, Hospital Universitario Sanitas La Moraleja, Spain. Electronic address: emiliomatute@gmail.com. Department of Anesthesia, Hospital Universitario La Paz, Madrid. Spain. Electronic address: estibaliz.alsina@gmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: mrubionav@hotmail.com. CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición, Spain. Electronic address: lourdesgarrido@gmail.com. Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain. Electronic address: jose.cruz.sspa@juntadeandalucia.es.

International journal of cardiology. 2017;:73-80
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Abstract

PURPOSE Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.

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