ABSTRACT

The cardioprotective effects of total intravenous anaesthesia and inhalational anaesthesia were compared in patients with a history of myocardial infarction within the last six months undergoing on-pump coronary artery bypass graft surgery (CABG).

Forty consecutive patients were divided into two groups in a prospective, randomized study. Infusions of fentanyl and propofol were used for induction and maintenance of anaesthesia in the total intravenous anaesthesia (TIVA) group (n=20). In the inhalation anaesthesia (SEVO) group (n=20), sevoflurane and infusion of fentanyl were used. Intravenous rocuronium was used in both groups and mean arterial pressure was kept above 50 mmHg during surgery. Serum creatinine phosphokinase MB fraction (CK-MB), cardiac isoform of troponin I (cTnI), liver enzymes, and brain natriuretic peptide (BNP) values were collected before operation, and 24 and 72 hours after operation. Perioperative risk factors and duration of intensive care unit stay were investigated.

There was no difference between groups in terms of baseline characteristics and serum CKMB levels before operation, or 24 and 72 hours after operation. The postoperative serum troponin levels at 24 and 72 hours after operation were lower in the SEVO group than in the TIVA group (p=0.017, p=0.003, respectively). Likewise, the postoperative serum BNP levels at 24 and 72 hours after operation were lower in the SEVO group than in the TIVA group (p=0.039, p=0.004, respectively). Perioperative risk factors did not differ between groups.

In patients with a history of MI during the last six months prior to on-pump CABG surgery, sevoflurane anaesthesia provides better myocardial protection than total intravenous anaesthesia.

Keywords: Total intravenous anaesthesia, inhalation anaesthesia, coronary artery bypass graft surgery, cardiopulmonary bypass