Volatile agents for cardiac protection in noncardiac surgery: a randomized controlled study.

Abstract

OBJECTIVE:

Volatile anesthetics reduce the risk of myocardial infarction and mortality in coronary artery surgery. Recently, the American College of Cardiology/American Heart Association Guidelines suggested the use of volatile anesthetic agents for the maintenance of general anesthesia during noncardiac surgery in patients at risk for perioperative myocardial ischemia, but no randomized experience to document the cardioprotective effects of these agents exists in this setting. Therefore, the authors performed a prospective, randomized, controlled trial to compare the effects of sevoflurane versus total intravenous anesthesia, in terms of postoperative cardiac troponin I release in patients undergoing noncardiac surgery.

DESIGN:

A randomized, controlled trial.

SETTING:

A teaching hospital.

PARTICIPANTS:

Eighty-eight consecutive patients undergoing noncardiac surgery.

INTERVENTIONS:

Patients were allocated randomly to receive either volatile anesthetic (44 patients) as the main anesthetic agent or total intravenous anesthesia (TIVA) (44 patients).

MEASUREMENTS:

Postoperative cardiac troponin I release was measured as a marker of myocardial necrosis. Patients with detectable postoperative troponin I in the sevoflurane group (12/44, 27.3%) were similar to those in the propofol group (9/44, 20.5%; p = 0.6). There was no significant reduction of postoperative median peak cTnI release (0.16 ± 0.71 ng/mL in the sevoflurane group compared with the TIVA group, 0.03 ± 0.08 ng/mL; p = 0.4). Three patients died at the 1-year follow-up for noncardiac causes (2 in the TIVA group).

CONCLUSIONS:

In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery.

• Authors: Alberto Zangrillo, Valentina Testa, Valeria Aldrovandi, Antonio Tuoro, Giuseppina Casiraghi, Francesca Cavenago, Melissa Messina, Elena Bignami, Giovanni Landoni
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 25 Issue 6 Pg. 902-7 (Dec 2011) ISSN: 1532-8422 [Electronic] United States
• PMID: 21872490 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Anesthetics, Inhalation
• Anesthetics, Intravenous
• Cardiotonic Agents
• Methyl Ethers
• Troponin I
• Sevoflurane
• Propofol

Topics

• Aged
• Anesthesia, Inhalation
• Anesthesia, Intravenous
• Anesthetics, Inhalation (therapeutic use)
• Anesthetics, Intravenous
• Cardiotonic Agents
• Female
• Humans
• Male
• Methyl Ethers
• Middle Aged
• Necrosis
• Propofol
• Prospective Studies
• Sevoflurane
• Surgical Procedures, Operative (methods)
• Troponin I (blood)