The Effects of Sevoflurane, Isoflurane and Propofol During Cardiac Surgery
Condition: Coronary Artery Disease; Mitral Valve Insufficiency; Aortic Valve Insufficiency
MeSH terms: Coronary Artery Disease; Mitral Valve Insufficiency; Aortic Valve Insufficiency
Study type: Interventional
Phase: Phase 1

Summary: 
      Abstract Anaesthetic support for cardiac surgery significantly influences the course of the
      intraoperative period and the success of the postoperative period. Total intravenous
      anaesthesia and inhalation anaesthesia are the traditional methods of anaesthesia in cardiac
      surgery. However, there are few studies assessing the effectiveness of surgical aggression
      protection in cardiac surgery.

      Objectives: To study the effectiveness of body protection against surgical aggression by TIVA
      and inhalational anaesthesia in cardiac surgery.

      Materials and methods. The examination and treatment data of 89 patients were included in the
      study. All patients underwent coronary artery bypass grafting, mitral valve
      replacement/plasty, aortic valve replacement cardiopulmonary bypass conditions.

      The patients were divided into 2 groups according to the type of disease: the first (1) group
      with coronary heart disease. The second (2) group with valvular heart disease. There were 65
      patients in the first group and 22 in the second. Both groups were divided into 3 subgroups
      according to the type of anaesthesia: patients anaesthetised with propofol, with sevoflurane,
      with isoflurane.
    

Detailed description: 
      All patients were divided into 2 groups according to the type of disease: the first (1) group
      with coronary heart disease. The second (2) group with valvular heart disease. There were 65
      patients in the first group and 22 in the second. Both groups were divided into 3 subgroups
      according to the type of anaesthesia: patients anaesthetised with propofol, with sevoflurane,
      with isoflurane.

      The study was conducted in 5 stages:

        1. Initial haemodynamic parameters and oxygen transport function of the patient's blood
           before anaesthesia were determined;

        2. after tracheal intubation;

        3. Before the CPB;

        4. after the CPB;

        5. The post-operative period until the patient is extubated. Before induction into
           anaesthesia, haemodynamic monitoring was started on admission to the operating theatre
           using a Nihon Kohden monitor (Japan). The right radial artery was catheterised for
           invasive monitoring of systemic arterial pressure and arterial blood sampling, and a
           catheter was then inserted into the central jugular vein (under ultrasound machine
           control) and guided into the right atrium for mixed venous blood sampling.

      Cardiac stroke volume was determined by transthoracic echocardiography (CS=end diastolic
      volume - end systolic volume). Cardiac output (CO=CS x heart rate), cardiac index (CI=CO/body
      surface area) were determined. We determined blood oxygen content using the formula CaO2
      (arterial ABB) and CvO2 (central mixed venous ABB) = [(1.34 × Hb × SO2) + (PO2 × 0.031)] /
      100. Arteriovenous difference = CaO2-CvO2. Oxygen delivery was determined using the formula
      (DO2 = CI* CaO2). Oxygen consumption (VO2 = Cardiac index (CI)*AVD or VO2 = CO × (CaO2 -
      CvO2) ~ CO × Hb × 1.34 × (SaO2 - SvO2) / 100).

      In the second stage, after tracheal intubation, indirect calorimetry was used to determine
      VO2, energy expenditure during anaesthesia using a Spirometry device (Oxford, UK), which was
      connected to an endotracheal tube and continuously showed oxygen demand and energy
      expenditure. A transesophageal echocardiography sensor was used to determine cardiac output.
      Additionally, the cardiac output was determined by Fick's formula in patients with CHD. The
      same tests (cardiac output, cardiac index, consumption, oxygen delivery, energy expenditure)
      were performed in the third and fourth stages of anaesthesia. In the last stage, the
      consumption of muscle relaxants and opioid analgesics was calculated to assess the
      pharmaco-efficiency of anaesthetics. The time of extubation and the time of transfer of the
      patient to the specialist department were determined.

      All patients continued antihypertensive medication both before and on the day of surgery to
      prevent the development of withdrawal syndrome and to reduce the risk of perioperative
      myocardial ischaemia.

      All patients in both groups were anesthetized with fentanyl at a dose of 5-7 µg/kg, ketamine
      1.5-2 mg/kg, and propofol 1-1.5 mg/kg intravenously fractionally. Pipecuronium bromide
      0.04-0.07 mg/kg was used as muscle relaxant in all patients. To maintain anaesthesia in Group
      1 P, propofol was used as an anaesthetic in a dose of 4-6 mg/kg/h intravenously on a perfusor
      (BBRAUN). In Group 2, sevoflurane was used as an anaesthetic in a dose of - 1.7-1.9 MAC. In
      Group 3 isoflurane was used as the anesthetic in the dose of 1.1-1.2 MAC. Fentanyl 100 µg
      intravenously was administered fractionally in all groups to increase heart rate and blood
      pressure, and pipecuronium bromide 2 mg intravenously for myorelaxation. During CPB, propofol
      at a dose of 6 mg/kg/h intravenously via perfusion was used in all patients in all groups.
      Anaesthesia regimen: fentanyl 100 µg IV every 30 min; myorelaxant pipecuronium bromide 2 mg
      every 40-60 min. Norepinephrine solution was administered at a dose of 0.07 µg/kg/min
      intravenously on perfusion and dobutamine 5 µg/kg/min after CPB in all patients at the same
      dosages in all groups.
    

Intervention name(s): Propofol; Isoflurane; Sevoflurane
Intervention type(s): Drug; Drug; Drug
Intervention description(s): To maintain anaesthesia in Group 1 P, propofol was used as an anaesthetic in a dose of 4-6 mg/kg/h intravenously on a perfusor; Isoflurane; Sevoflurane
Other intervention name(s): Propofol;; В качестве анестетика использовали изофлуран - 1,1-1,2 ПДК.; в качестве анестетика использовали севофлуран в дозе - 1,7-1,9 ПДК.
Intervention MeSH terms: Propofol; Sevoflurane; Isoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: heart valve; CHD; sevoflurane; propofol; isoflurane