Abstract
Objective To compare the effects of sevoflurane and isoflurane on perioperative myocardial injury in elderly hypertensive patients. Methods Thirty-six patients with hypertension of Ⅱ degree aged>64 yr undergoing elective chest surgery were randomly divided into three groups of 12 patients each: group Ⅱ sevoflurane (Sevo); group Ⅱ isoflurane (Iso) and group Ⅲ propofol (Pro). The patients were premedicated with intramuscular midazolam 5 mg and iv scopolamine 0.3 mg. Anesthesia was induced with TCI of sufentanil (target Cp=0.5 ng/ml) and iv midazolam 0.025-0.050 mg/kg. Tracheal intubation was facilitated with pipecuronium as soon as the patients lost consciousness. The patients were mechanically ventilated. PaCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with 1.7% sevoflurane, or 1.2% isoflurane or propofol TCI (target Cp =2-3 μg/ml). ECG, HR, BP, CVP, SpO2, end-tidal PCO2 and BIS were continuously monitored during operation. BIS was maintained at 40-60. The changes in ST segment were recorded before anesthesia, after intubation and surgical exploration and immediately after extubation. Myocardial ischemia was defined as ST segment depression ≥0.1 mV for more than 1 min. Blood samples were obtained from peripheral vein of upper limb, before anesthesia (T0), 1 h after skin incision (T1), at the end of operation (T2) and 3, 6, 12, 24 h after operation (T3-6) for determination of plasma CK-MB activity and plasma concentrations of cTnI, IL-6, CRP and slCAM-1. Results The ST segment depression was significantly deeper after extubation in group Pro than in group Sevo and Iso. The plasma CK-MB activity and cancentratioas of cTnl, IL-6, CRP and slCAM-1 were significantly increased after operation in all 3 groups. The plasma levels of cTnI, IL-6, CRP and slCAM-I were significantly higher in group Pro than in group Sevo and Iso. Conclusion Myocardial injury is less severe during the first 24 h after chest operation performed under sevoflurane or isoflurane anesthesia than under propofol anesthesia. Key words: Isoflurane; Propofol; Hypertension; Myocardial injury; Sevoflurane
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