open access

Vol 50, No 3 (2018)
Original and clinical articles
Published online: 2018-06-18
Submitted: 2017-08-23
Accepted: 2018-06-14
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Comparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study

Marcin Wąsowicz, Angela Jerath, Warren Luksun, Vivek Sharma, Nicholas Mitsakakis, Massimilaino Meineri, Rita Katznelson, Terrence Yau, Vivek Rao, William Scott Beattie
DOI: 10.5603/AIT.a2018.0012
·
Pubmed: 29913033
·
Anaesthesiol Intensive Ther 2018;50(3):200-209.

open access

Vol 50, No 3 (2018)
Original and clinical articles
Published online: 2018-06-18
Submitted: 2017-08-23
Accepted: 2018-06-14

Abstract

Background: Clinical trials have shown conflicting results regarding the use of volatile anaesthesia before or after
an ischaemic insult in cardiac surgical patients and its effect on myocardial injury. This may be attributable to the
failure of continuing volatile agents into the early postoperative period. We hypothesised that combined volatilebased
anaesthesia and postoperative sedation would decrease the extent of myocardial injury after coronary artery
bypass grafting (CABG) when compared with an intravenous, propofol-based approach. This study aimed to assess
the feasibility of the perioperative protocol and investigate whether volatile anaesthesia provides cardioprotection
in patients undergoing CABG.


Methods: Randomized, controlled trial enrolling 157 patients with preserved left ventricular function scheduled for
elective or urgent on-pump CABG. Patients received either volatile- or propofol-based anaesthesia and postoperative
sedation. Volatile sedation in the ICU was provided with the use of the AnaConDa® device (Sedana Medical, Uppsala,
Sweden). The primary outcome was myocardial injury measured by serial troponin measurement at the beginning
of surgery, 2, 4 and 12–16 h after ICU admission. The secondary outcome was cardiac performance expressed as
cardiac index (CI) and the need for inotropic and vasopressor drug support. The peak postoperative troponin level
was defined as the highest level at any time in the first 16 h after surgery.


Results: 127 patients completed the study protocol, 60 patients in the volatile group and 67 patients in the propofol
group. Troponin levels were similar between groups at all of the measured time points. There were no differences
in cardiac index or vasoactive drug support except for the immediate post- cardiopulmonary bypass (CPB) period
when patients in the volatile group had low systemic vascular resistance, high CI and required more vasopressors.
There was no difference in postoperative kidney function, intensive care unit discharge or hospital discharge time.


Conclusions: The use of volatile-based anaesthesia and postoperative sedation did not confer any cardioprotection
compared with propofol-based anaesthesia and sedation in patients who had good left ventricular function and
were undergoing CABG.

Abstract

Background: Clinical trials have shown conflicting results regarding the use of volatile anaesthesia before or after
an ischaemic insult in cardiac surgical patients and its effect on myocardial injury. This may be attributable to the
failure of continuing volatile agents into the early postoperative period. We hypothesised that combined volatilebased
anaesthesia and postoperative sedation would decrease the extent of myocardial injury after coronary artery
bypass grafting (CABG) when compared with an intravenous, propofol-based approach. This study aimed to assess
the feasibility of the perioperative protocol and investigate whether volatile anaesthesia provides cardioprotection
in patients undergoing CABG.


Methods: Randomized, controlled trial enrolling 157 patients with preserved left ventricular function scheduled for
elective or urgent on-pump CABG. Patients received either volatile- or propofol-based anaesthesia and postoperative
sedation. Volatile sedation in the ICU was provided with the use of the AnaConDa® device (Sedana Medical, Uppsala,
Sweden). The primary outcome was myocardial injury measured by serial troponin measurement at the beginning
of surgery, 2, 4 and 12–16 h after ICU admission. The secondary outcome was cardiac performance expressed as
cardiac index (CI) and the need for inotropic and vasopressor drug support. The peak postoperative troponin level
was defined as the highest level at any time in the first 16 h after surgery.


Results: 127 patients completed the study protocol, 60 patients in the volatile group and 67 patients in the propofol
group. Troponin levels were similar between groups at all of the measured time points. There were no differences
in cardiac index or vasoactive drug support except for the immediate post- cardiopulmonary bypass (CPB) period
when patients in the volatile group had low systemic vascular resistance, high CI and required more vasopressors.
There was no difference in postoperative kidney function, intensive care unit discharge or hospital discharge time.


Conclusions: The use of volatile-based anaesthesia and postoperative sedation did not confer any cardioprotection
compared with propofol-based anaesthesia and sedation in patients who had good left ventricular function and
were undergoing CABG.

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Keywords

anaesthetics, volatile; anaesthetics, intravenous, propofol; pre-conditioning; post-conditioning; cardiac surgery

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About this article
Title

Comparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 3 (2018)

Pages

200-209

Published online

2018-06-18

DOI

10.5603/AIT.a2018.0012

Pubmed

29913033

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(3):200-209.

Keywords

anaesthetics
volatile
anaesthetics
intravenous
propofol
pre-conditioning
post-conditioning
cardiac surgery

Authors

Marcin Wąsowicz
Angela Jerath
Warren Luksun
Vivek Sharma
Nicholas Mitsakakis
Massimilaino Meineri
Rita Katznelson
Terrence Yau
Vivek Rao
William Scott Beattie

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