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Eur J Cardiothorac Surg 2007;32:319-325. doi:10.1016/j.ejcts.2007.05.005
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
a Cardiothoracic Surgery Unit and Intensive Care Department, "Centro Malan" Istituto Clinico Sant’Ambrogio, Milan, Italy
b Chief Anaesthesia and Intensive Care Department, "Centro Malan" Istituto Clinico Sant’Ambrogio, Milan, Italy
c Anaesthesia and Intensive Care Department, "Centro Malan" Istituto Clinico Sant’Ambrogio, Milan, Italy
Received 1 February 2007; received in revised form 1 May 2007; accepted 7 May 2007.
* Corresponding author. Address: Cardiothoracic Surgery Unit and Intensive Care Department, Istituto Clinico Sant’ Ambrogio, Via Faravelli 16, 20171 Milan, Italy. Tel.: +39 02 331271; fax: +39 02 33127730. (Email: massimo.meco{at}virgilio.it).
Background: Recent clinical and experimental data indicate that volatile anaesthetics may precondition myocardium against ischaemia and infarction. The present clinical trial was designed to verify the cardioprotective effects of desflurane in patients undergoing elective coronary artery bypass surgery. It was hypothesized that desflurane preconditioning would decrease postoperative release of troponin I and brain natriuretic peptide (NT-proBNP). Besides, we have hypothesized that desflurane preconditioning would preserve the myocardium from the dysfunction following cardioplegic arrest. Methods: Twenty-eight patients were randomly divided into two groups: Control group (14 patients) and Desflurane group (14 patients). In Desflurane group (DS) patients, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-min exposure to desflurane (2.5 minimum alveolar concentration), followed by a 10-min washout before aortic cross-clamping and cardioplegic arrest. The control group (C) patients underwent an equivalent period (15 min) of pre-arrest desflurane-free bypass. Haemodynamic measurements were obtained at six different times. The biochemistry markers of cellular damage and myocardial dysfunction (troponin I, NT-proBNP) were determined. Left ventricular (LV) function was assessed using tissue Doppler imaging (TDI) of mitral annulus. Two-factor repeated-measures analysis of variance was used to evaluate differences over time between groups for all parameters determined in plasma samples and for all TDI-derived variables. Results: After surgery, both the troponin I values (2.04 ± 1.09 ng/ml vs 1.44 ± 0.77 ng/ml, p < 0.01 after 24 h and 1.62 ± 0.96 ng/ml vs 1.00 ± 0.24 ng/ml, p < 0.01 after 72 h respectively) and those of the NT-proBNP (2187 ± 282.9 ng/l vs 885.4 ± 117.35 ng/l, p < 0.01 after 24 h and 3097.9 ± 226.2 vs 1393.6 ± 312.07 ng/l, p < 0.01 after 72 h respectively) were less in the desflurane-treated patients. The values of TDI of mitral annulus were constantly better in desflurane-treated patients. Conclusions: We can conclude that the use of desflurane in these patients provides a pharmacological preconditioning so as to reduce myocardial necrosis and improve the cardiac performance in the postoperative period.
Key Words: Heart • Coronary artery bypass • Myocardial preservation • Anaesthetics volatile • Desflurane
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