open access

Vol 46, No 1 (2014 Jan-Mar)
Original and clinical articles
Submitted: 2014-03-11
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Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Paweł Mroziński, Romuald Lango, Aleksandra Biedrzycka, Maciej Michał Kowalik, Rafał Pawlaczyk, Jan Rogowski
DOI: 10.5603/AIT.2014.0002
·
Anaesthesiol Intensive Ther 2014;46(1):4-13.

open access

Vol 46, No 1 (2014 Jan-Mar)
Original and clinical articles
Submitted: 2014-03-11

Abstract

Background: Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery.

Methods: Design: Prospective, randomised open-lable study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume.

Results: No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: –14.3 and –19.8 [g m m-2 beat-1]), respectively (P = 0.029). Oxygen uptake index (VO2I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration.

Conclusions: This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism. Clinical trial registration information: NCT00528515 (http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1)

Abstract

Background: Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery.

Methods: Design: Prospective, randomised open-lable study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume.

Results: No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: –14.3 and –19.8 [g m m-2 beat-1]), respectively (P = 0.029). Oxygen uptake index (VO2I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration.

Conclusions: This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism. Clinical trial registration information: NCT00528515 (http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1)

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Keywords

anaesthetics, intravenous; anaesthetics, inhalation; haemodynamics; coronary artery bypass, off-pump; oxygen consumption

About this article
Title

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 46, No 1 (2014 Jan-Mar)

Pages

4-13

DOI

10.5603/AIT.2014.0002

Bibliographic record

Anaesthesiol Intensive Ther 2014;46(1):4-13.

Keywords

anaesthetics
intravenous
anaesthetics
inhalation
haemodynamics
coronary artery bypass
off-pump
oxygen consumption

Authors

Paweł Mroziński
Romuald Lango
Aleksandra Biedrzycka
Maciej Michał Kowalik
Rafał Pawlaczyk
Jan Rogowski

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