Prolonged sevoflurane administration in the off-pump coronary artery bypass graft surgery: Beneficial effects

Abstract

PurposeThe benefits of intraoperative administration of halogenated agents in patients undergoing cardiac surgery have been shown by numerous studies. The mechanisms of preconditioning and postconditioning appear to be the cause of these benefits. The possibility of maintaining the early postoperative sedation with halogenated agents, after its intraoperative administration, can increase their benefits. Patients and methodsThis is a prospective trial with 60 patients undergoing coronary artery bypass graft surgery divided into 3 groups according to the administration of hypnotic drugs in the intraoperative and postoperative periods (sevoflurane, sevoflurane: SS, sevoflurane-propofol: SP, propofol-propofol: PP). For the first 48 hours, hemodynamic parameters, the need for inotropic drugs, N-terminal pro-brain natriuretic peptide, and troponin I plasmatic concentrations were obtained. ResultsThere were significant differences between group SS and the other 2 groups in the levels of N-terminal pro-brain natriuretic peptide (SS [501 ± 280 pg/mL] compared with SP [1270 ± 498 pg/mL] and PP [1775 ± 527 pg/mL] [P < .05]) and troponin I (SS [0.5 ± 0.4 ng/mL] compared with SP [1.61 ± 1.30 ng/mL] and PP [2.27 ± 1.5 ng/mL] [P < .05]) and a lower number of inotropic drugs. ConclusionSevoflurane administration in patients undergoing off-pump coronary artery bypass graft, in the operating room and the intensive care unit, decreases myocardial injury markers compared with patients who only received sevoflurane in the intraoperative period, but both were a better option to decrease levels of myocardial markers when compared with the propofol group.