Desflurane,Brain Natriuretic Peptide and Cardiac Surgery
Condition: Brain Natriuretic Peptide; Coronary Artery Bypass Graft Surgery; Cardiac Surgery; Cardiopulmonary Bypass; Desflurane; Outcome
Study type: Interventional

Summary: 
      During coronary artery bypass grafting (CABG) operations with cardiopulmonary bypass (CPB),
      the use of desflurane continuously or intermittently may have effects on serum brain
      natriuretic peptide (BNP) levels. The aim is to investigate the association between
      desflurane, serum BNP values, and clinical outcomes during CABG operations. In a prospective,
      randomized, double-blinded study, desflurane inhalational anesthesia was administered either
      continuously or intermittently (Group 1; n=60 versus Group 2; n=62). The preoperative and
      postoperative BNP levels at 24, 48 and 72 hours after surgery were collected. Outcomes were
      recorded.
    

Detailed description: 
      Background: During coronary artery bypass grafting (CABG) operations with cardiopulmonary
      bypass (CPB), the use of desflurane continuously or intermittently may have effects on serum
      brain natriuretic peptide (BNP) levels.

      Aim of the study: The aim is to investigate the association between desflurane, serum BNP
      values, and clinical outcomes during CABG operations.

      Material and methods: In a prospective, randomized, double-blinded study, desflurane
      inhalational anesthesia was administered either continuously or intermittently (Group 1; n=60
      versus Group 2; n=62). The preoperative and postoperative BNP levels at 24, 48 and 72 hours
      after surgery were collected. Outcomes were recorded. Randomization into two groups was
      performed using sealed envelopes. The sequentially numbered assignments of participants were
      concealed in these envelopes during the study. The patients enrolled in the study receive an
      allocation to a group after anesthesia induction by health care personnel after the opening
      of the envelope. The observers were blinded to the anesthetic protocol. Caregivers were not
      blinded, but they did not participate in data collection or data interpretation. Therefore,
      the study protocol is considered double-blinded, masked to observers. Inclusion criteria
      include; 18 to 75 years of age, body mass index of 25 to 31, ejection fraction≥50%. Exclusion
      criteria include; repeat cardiac surgery, emergent surgery, preoperative coagulation
      disorder, preoperative congestive heart failure, ejection fraction <49%, preoperative renal
      dysfunction (serum creatinine>1.3 mg/dL), dialysis, preoperative hepatic dysfunction (serum
      aspartate/alanine amino transferase>40 U/L), preoperative electrolyte imbalance, history of
      pancreatitis or current corticosteroid treatment.The primary endpoint was to determine
      preoperative and postoperative BNP values 24, 48 and 72 hours after surgery. The secondary
      endpoint was the relation between BNP values and clinical outcomes such as; 1-Aortic
      cross-clamp time, 2-Cardiopulmonary bypass time, 3-The use of inotropic support,
      4-Intra-aortic balloon pump, 5-Duration of mechanical ventilation (>48 hours), 6-Development
      of pneumonia, 7-Perioperative myocardial infarction, 8-Cerebrovascular event (stroke or
      transient ischemic attack), seizure, 9-Atrial fibrillation and other rhythm disturbances,
      10-Need for renal replacement therapy (RRT), 11-Reoperation secondary to bleeding,
      12-Intensive care unit stay (>3 days), 13-Hospital stay and, 14-Thirty-day mortality.

      Statistical analysis. The sample size was calculated according to the comparison of serum BNP
      values in a previous study and a sample size of 58 patients per group would be required with
      80% power and the conventional 2-sided type 1 error of 5%. A multiple logistic regression
      analysis was performed to assess the predictive factors for weaning failure from mechanical
      ventilation, and the significance level was set at a p-value of less than 0.10 in the
      univariate model. To determine the best cut-off for preoperative BNP value to predict the
      development of prolonged mechanical ventilation, we calculated the area under the receiver
      operating characteristic curve.
    

Intervention name(s): Desflurane Inhalational agent
Intervention type(s): Drug
Intervention description(s): Desflurane inhalational agent administration during the whole cardiac surgical operation with cardiopulmonary bypass versus administration of desflurane inhalational agent before and after cardiopulmonary bypass during the whole period of cardiac surgical operation.
Other intervention name(s): Suprane
Intervention MeSH terms: Desflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: In a prospective, randomized, double-blinded study, desflurane inhalational anesthesia was administered either continuously or intermittently (Group 1; n=60 versus Group 2; n=62).
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care