Protective effect of isoflurane on myocardia in patients with abdominal aortic aneurysm

Abstract

Objective To study the protective effect of isoflurane on myocardia in patients with abdominal aortic aneurysm under extracorporeal circulation.Methods A total of 80 patients with abdominal aortic aneurysm who took abdominal aorta replacement surgery under the normal temperature and extracorporeal circulation were randomly divided into isoflurane group or sevoflurane group (n =40 each).The heart rate (HR),mean arterial pressure (MAP) and central venous pressure (CVP) were recorded on the time points of entering the operation room,cutting skin,entering the abdominal cavity,and completing the operation,meanwhile cardiac adverse events during the whole operation were also recorded.Plasma concentration of creatine kinase-MB (CK-MB) and cardiac troponin Ⅰ (cTnⅠ) at the time points of cutting skin,end of the operation,2 h and 4 h after operation.Results The incidence of cardiovascular adverse events between isoflurane group (52 cases) and sevoflurane group (65 cases) had no significant difference (P ＞0.05).When getting into the abdominal cavity,HR [(63.5 ±5.0) beats/min] and MAP [(84.3 ±3.9) mmHg (1 mmHg =0.133 kPa)] in isoflurane group were increased as compared with sevoflurane group [(59.5 ± 5.0) beats/min and (78.4 ± 4.1) mmHg],and at the end of the surgery the MAP [(73.8 ± 3.1) mmHg] in isoflurane group was higher than in sevoflurane group [(70.8 ± 5.8) mmHg,P ＜0.05].The cTnⅠ in isoflurane group [(0.99 ± 0.22) μg/L] was lower than in sevoflurane group [(1.17 ±0.29) μg/L] at the end of the surgery (P ＜0.05).At 2 h postoperation,the plasma CK-MB [(2.33 ±0.67) U/L] and eTnⅠ [(1.03 ± 0.31) μg/L] in isoflurane group were lower than in sevoflurane group [(2.98 ± 0.36) U/L and (1.38 ± 0.33) μg/L,P ＜ 0.05],and at 4 h postoperation the C K-MB [(3.09 ± 0.51) U/L] and cTnⅠ [(1.15 ± 0.42) μg/L] in isoflurane group were lower than in sevofluranegroup [(5.87±0.23) U/Land (1.53±0.62) μg/L,P＜0.05].Conclusion Inthe treatment of abdominal aortic aneurysm under the normal temperature of extracorporeal circulation,isoflurane as an anesthesia drug is more potent protection on myocardium.It can also reduce the effect of myocardial ischemia-reperfusion injury. Key words: Extracorporeal circulation ; Abdominal aortic aneurysm ; Isoflurane ; Myocardial protection