Sevoflurane versus propofol in cardioanesthesia in patients undergoing coronary artery surgery with cardiopulmonary bypass

Background: The anesthesia is a reversible pharmacological condition which is caused by the administration of anesthetic drugs. The maintenance of anesthesia in patients undergoing coronary artery bypass surgery can be achieved either by continuous intravenous administration of propofol or by inhaled volatile anesthetic gas such as sevoflurane. Aim: The aim of the present systematic review was to investigate the cardioprotective effect of propofol and sevoflurane in cardioanesthesia. Method: A critical review of research articles was made, using the electronic databases Cinahl, Medline, Scopus, Google Scholar and Heal-Link for the period 1990-2015, with the key words: propofol, sevoflurane, propofol versus sevoflurane, coronary artery bypass, coronary artery bypass grafting, troponin, cardiac anesthesia, cardiac biomarker, ischemia, volatile, intravenous, monitoring. The inclusion criteria were the English language, the articles had to be original or meta-analyses, and to be topic relevant. Totally, 16 articles were included. Results: The results for the cardiac output are controversial. A study support that the cardiac ejection fraction is lightly increased in the propofol group and another study in the sevoflurane group. The patients with propofol had significantly lower mean arterial pressure than those with sevoflurane. The heart rates of patients did not differ significantly, since the decrease of the heart rates preoperative until the first hour from the beginning of the surgery was greater to the sevoflurane group. Most studies have shown the cardioprotective effects of the volatile anesthetic drugs in patients undergoing coronary artery surgery with and without extracorporeal circulation, referred decrease of the risk of heart attack and the mortality from any cause, higher cardiac index score, less length of stay both intensive care unit and hospital totally. Also, they supported that the use of volatile drugs was associated with significant reduction in the maximum concentration of cardiac troponine I and the cardiac enzyme CKMB. In contrast, there are studies that found no differences in the postoperative release of troponine among the two group of patients. Conclusions: Among patients undergoing coronary artery bypass surgery, the anesthesia with sevoflurane maintain better cardiac performance, suggesting that the sevoflurane may have cardioprotective effects during the cardiosurgery.

Category: Volume 54, N 4
Hits: 423 Hits
Created Date: 15-12-2015
Authors: Vasiliki Katsiaoni , George Intas , Argyra Erifyli