Effect of Anesthetics on Troponin I and С-reactive Protein
Condition: Mitral Valve Insufficiency; Aortic Valve Insufficiency; Cardiac Disease
MeSH terms: Heart Diseases; Mitral Valve Insufficiency; Aortic Valve Insufficiency
Study type: Interventional
Phase: Phase 1

Summary: 
      Abstract Troponin is one of the cardiac biomarkers and its high level correlates to high risk
      of cardiac myocytes damage. C-reactive protein (CRP) in cardiosurgery participates in the
      Systemic Inflammation Response Syndrome, and heart-lung apparatus is a powerful stimulator of
      the systemic inflammatory reaction.

      Objective: To assess effect of anesthetics on troponin I and СRP in mitral, tricuspid and
      aortic valve replacement/plastic in adult.

      Methods. Single-center prospective randomized controlled clinical study. A total of 95
      patients were assigned randomly into three groups according to the type of anesthesia: the
      first group of 32 patients with propofol, the second group with sevoflurane - 32 patients,
      and the last - 31 patients were with isoflurane.

      Levels of the cardiac troponin I were calculated in ng/ml с using a portable fluorometric
      analyzer I-CHROMAII, manufacture of BoditechMedInc (South Korea). Normal range: <0.04 ng/ml.
      CRP concentration in plasma has been determined using a biochemical analyzer Biosystems
      BA-200 (Spanish company, Barcelona) according to the manufacturer's instructions. The normal
      level of CRP is less than 5 mg/l.
    

Detailed description: 
      The examination and treatment data of 95 patients operated in the departments of
      cardiovascular surgery of the City multidisciplinary hospital No. 2 were included in the
      study. All patients underwent mitral, aortic, tricuspid valve replacement/plasty under
      cardiopulmonary bypass (CPB) conditions. This research work was conducted between 2021 and
      2023. To calculate the sample size, we used the formula n=t2*D*N/confidence interval*N+t2*α,
      which will allow to identify the static significance of the study.

      Inclusion criteria: insufficiency of mitral, tricuspid and aortic valves of 3-4th degree;
      only planned surgeries; age range 40-60 years old; patients corresponding to II-III grade
      according to the scale of the American Society of Anaesthesiologists.

      Exclusion criteria: pregnancy; acute coronary syndrome; hemodynamic instability.

      All patients were assigned randomly into three groups according to the type of anesthesia:
      the first group of 32 patients with propofol, the second group with sevoflurane - 32
      patients, and the last - 31 patients were with isoflurane.

      The level of cardiac troponin I were calculated in ng/ml using a portable fluorometric
      analyzer i-CHROMAII, production of BoditechMedInc (South Korea). The normal range: <0.04
      ng/ml. The analyzer Triage® Meter Pro of Alere San Diego Inc. production (USA).

      Three blood samples were taken in the patients before the anaesthesia, in 12 hours
      post-surgery and in 48 hours post-surgery. Blood samples were taken in the sterile
      test-tubes, containing no EDTA and heparin, centrifugated and stored at temperature -20 °С to
      avoid the erroneously low results.

      CRP concentrations in plasma were determined using the biochemical analyzer Biosystems BA-200
      (Spanish company, Barcelona) according to the manufacturer's instructions. The normal level
      of CRP is less than 5 mg/l. Blood samples were taken in the patients before the anaesthesia,
      1st day post-surgery, 3rd and 5th days post-surgery.
    

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; В качестве анестетика использовали изофлуран - 1,1-1,2 MAC.; в качестве анестетика использовали севофлуран в дозе - 1,7-1,9 ПДК.
Other intervention name(s): Propofol;
Intervention MeSH terms: Propofol; Sevoflurane; Isoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Mitral Valve Insufficiency; Aortic Valve Insufficiency; Troponin I; propofol; isoflurane; sevoflurane