Original ArticlesDoes isoflurane optimize myocardial protection during cardiopulmonary bypass?*
Section snippets
Methods
Forty-nine patients undergoing elective CABG surgery with CPB were prospectively studied after approval of the institutional review committee. Exclusion criteria included diabetes mellitus, recent myocardial infarction (<1 month), unstable angina, renal failure, and prior CABG surgery. Patients were randomly assigned into 2 groups: Group I (28 patients) received isoflurane during the pre-CPB period. Group II (21 patients) served as a control with no inhalation anesthetic administration.
Patients
Results
The control and isoflurane groups were matched for age, sex, body surface area, and number of coronary arteries grafted (Table 1). NOTE. Values are mean ± SD. No significant difference was found between the 2 groups. Abbreviation: BSA, body surface area.Empty Cell Control Group (n = 21) Isoflurane Group (n = 28) Age (y) 60.9 ± 10.3 57.1 ± 8.6 Sex ratio (M/F) 16/5 22/6 BSA 1.9 ± 0.1 1.9 ± 0.2 No. grafts 2.7 ± 0.6 2.8 ± 0.6
Discussion
Clinically, the APC effect of isoflurane has been investigated in patients undergoing CABG surgery; the data support a cardioprotective effect of isoflurane as evidenced by a trend of consistently lower levels of CK-MB and troponin, which are sensitive markers of cellular necrosis.17 These findings may explain the present clinical results in patients undergoing CABG surgery, which show that the mean CI after weaning from CPB was significantly higher than the pre-CPB value in the isoflurane
References (21)
- et al.
Embracing the heart: Perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer
J Cardiothorac Vasc Anesth
(1999) - et al.
Anesthesia and minimally invasive thoracoscopically assisted coronary artery bypass: A brief clinical report
J Cardiothorac Vasc Anesth
(1997) - et al.
The role of ischemic preconditioning during minimally invasive coronary artery bypass graft surgery
J Cardiothorac Vasc Anesth
(1997) - et al.
Ischemic preconditioning improves preservation with crystalloid cardioplegia
Ann Thorac Surg
(1994) - et al.
Preconditioning the human myocardium
Lancet
(1993) - et al.
Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning
Ann Thorac Surg
(1997) - et al.
Ischemic preconditioning, cardioplegia or both?
J Mol Cell Cardiol
(1994) - et al.
Cardiopulmonary bypass, myocardial management and support techniques: Ischemic preconditioning in cardiac surgery: A word of caution
J Thorac Cardiovasc Surg
(1996) - et al.
Mechanisms of myocardial reperfusion injury
Ann Thorac Surg
(1999) - et al.
Protective effects of anesthetics in reversible and irreversible ischemia-reperfusion injury
Br J Anaesth
(1999)
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2013, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :In contrast to these findings, other investigators' results suggested that APC may indeed occur in patients undergoing CABG. For example, Haroun-Bizri et al demonstrated that administration of isoflurane to 28 elective CABG patients before cardiopulmonary bypass attenuated ST-segment changes and improved cardiac index compared with 21 controls who did not receive the volatile anesthetic.41 Meco et al used a preconditioning protocol in which 28 CABG patients were exposed to 2.5 MAC desflurane or placebo for 5 min followed by a 10-min anesthetic elimination period before aortic cross-clamping and cardioplegic arrest.42
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Address reprint requests to Anis Baraka, MD, FRCA, Department of Anesthesiology, American University of Beirut, PO Box 113-6044, Beirut, Lebanon. E-mail: [email protected]