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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Cardioprotective Effect of Sevoflurane in Patients Undergoing Coronary Artery Bypass Grafting

Background

The cardioprotective effect of sevoflurane have been proven in experimental and clinical studies. However, it has not been studied so far if this effect on the myocardium is more expressed before the onset of myocardial ischaemia (preconditioning) or after (postconditioning). The aim of this study was to determine whether the cardioprotective effect of sevoflurane was more expressed during the preconditioning or postconditioning phase of coronary bypass grafting operations.

Key words: cardioprotective effect, sevoflurane, volatile anaesthetics, myocardial ischaemia, preconditioning, postconditioning

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Anti-inflammatory action of sevoflurane in lung surgery with one lung ventilation

Background

In patients undergoing lung surgery mechanical ventilation and surgical trauma may induce alveolar and systemic inflammatory response. One-lung ventilation (OLV) has become as a standard procedure in thoracic surgery. It is also the main cause of acute inflammatory response and is associated with ALI and ARDS.

Demonstrating the influence of volatile anaesthetics on the inflammatory response and the treatment outcome in patients undergoing lung surgery with one lung ventilation (OLV) is still a great challenge.

The effects of sevoflurane on local release of inflammatory cytokines has been shown before. The added value of our study is that the systemic immunomodulatory effect of sevoflurane, postoperative clinical outcome and complications were tested.

The aim of the study was to prospectively investigate the systemic anti-inflammatory effect of the volatile anaesthetic sevoflurane in patients undergoing lung surgery with OLV.

Key words: one-lung ventilation, sevoflurane, inflammation

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Sevoflurane vs propofol in high risk cardiac surgery: design of the randomized trial “Sevo-Aifa”

Abstract

Objective. Recent evidence indicates that volatile anesthetics improve post-ischemic recovery. In a meta-analysis of 22 randomized studies, the use of volatile anesthetics was associated with significant reduction in myocardial infarction and mortality. All the studies in this meta-analysis included low risk patients undergoing isolated procedures (mostly isolated coronary artery bypass grafting). We want to confirm the cardioprotective effects of volatile anesthetics, in cardiac surgery, as indicated by a reduced intensive care unit stay and/or death in a high risk population of patients, undergoing combined valvular and coronary procedures.
Methods. Four centres will randomize 200 patients to receive either total intravenous anesthesia with propofol or anesthesia with sevoflurane. All patients will receive a standard average dose of opiates. Perioperative management will be otherwise identical and standardized. Transfer out of the intensive care unit will follow standard criteria.
Results. Reduced cardiac damage will probably translate into better tissue perfusion and faster recovery, as documented by a reduced intensive care unit stay. The study is powered to detect a reduction in the composite end point of prolonged intensive care unit stay (>2days) and/or death from 60% to 40%.
Conclusions. This will be the first multicentre randomized controlled trial comparing the effects of volatile anesthetics and total intravenous anesthesia in high risk patients undergoing cardiac procedures. Our trial should help clarify whether or not volatile agents should be recommended in high risk patients undergoing cardiac surgery.

Key words: anesthetic gases, cardiac surgical procedures, myocardium protection, sevoflurane, cardiac anesthesia, intensive care, volatile agents

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