Influence of two anesthetic methods on postoperative cardiac function in elderly patients with coronary artery disease

Abstract

Objective To explore the influence of inhalation anesthesia versus intravenous anesthesia on postoperative cardiac function in elderly patients with coronary artery disease, and to assess the effect of the two anesthesia schemes on controlling the incidence rate of postoperative adverse cardiovascular events in patients with versus without heart surgery. Methods 224 elderly patients with coronary artery disease admitted to our hospital were chosen from Jan. 2013 to Sep. 2015. Patients were randomly divided into the inhalation anesthesia group and the intravenous anesthesia group (n=112, each). The perioperative adverse cardiovascular events were considered as a primary endpoint, and the postoperative adverse cardiovascular events within 3 days after operation as a secondary endpoint in all patients. The univariate analysis and multivariate Logistic regression analysis were used to evaluate the risk factors for the adverse cardiovascular events after surgery. The influence of the two anesthesia methods on the incidence rate of postoperative adverse cardiovascular events was compared. Results Among 224 patients, 31 cases (13.8%) showed the perioperative adverse cardiovascular events, including 4 cases (1.8%) during surgery, 27 cases (12.1%) after surgery; 16 cases (14.3%) in inhalation group and 15 cases (13.4%) in intravenous group (16, 14.3% vs. 15, 13.4%, P>0.05). The independent risk factors for myocardial ischemia shown at the day of surgery were New York Heart Association (NYHA) class Ⅲ and intraoperative hypotension, those shown at second day after surgery were intraoperative hypotension, intravenous anesthesia, NYHA class Ⅲ, and those shown at third day after surgery were intraoperative hypertension and intravenous anesthesia (all P<0.05). Among 224 cases, 7 patients (3.1%) died after surgery, of which 2 cases had cardiac death and 5 cases had non-cardiac death. Conclusions The inhalation anesthesia effectively reduces the incidence of myocardial ischemic events in elderly patients within 3 days after surgery, but it does not improve the incidence of perioperative cardiac events and mortality. The inhalation anesthesia has a certain protective effect on myocardium, which is worthy of promotion. Key words: Anesthetic, inhalation; Anesthesia, intravenous; Coronary artery disease