Desflurane Versus Propofol Anesthesia for Off-Pump CABG
Condition: Coronary Artery Disease
MeSH terms: Coronary Artery Disease
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to prove if anesthesia maintained with the inhaled volatile
      anesthetic desflurane is superior to the intravenously applied propofol anesthesia in
      off-pump coronary artery bypass grafting (OP-CABG) surgery as measured by following
      parameters:

        1. hemodynamic parameters during and after the operation,

        2. pulmonary gas exchange, need for mechanical ventilation and for ICU and intrahospital
           stay,

        3. release of heart muscle injury markers in response to surgery and intraoperative
           ischaemia,

        4. inflammatory response to the operation.

      We suspect that insufflation anesthesia with desflurane may be superior to intravenous
      anesthesia with propofol.
    

Detailed description: 
      General anesthesia will be induced by intravenous dosis of fentanyl, vecuronium and etomidate
      and further maintained either by inhaled desflurane or propofol infusion, with concomitant
      empirically administered fentanyl doses and continuous infusion of vecuronium.

      After induction of anesthesia a Swan-Ganz catheter for continuous cardiac output, right
      ventricle end diastolic volume and blood saturation measurements will be introduced through
      the internal jugular vein. A transesophageal echocardiography probe will be placed
      additionally for the Tei-index measurement.

      Hemodynamic parameters will be recorded at the following time points:

        -  before induction

        -  after induction

        -  during trachea intubation

        -  before skin incision

        -  3 Min. after skin incision

        -  after sternotomy

        -  before heart positioning for graft placing

        -  before finishing placing each distal anastomoses

        -  10, 20, 30, 40 min after placing the last anastomoses

        -  10 Min. after admission to ICU, 6, 12, 18 and 24 hours after surgery.

        -  TEE measurements will be obtained after sternotomy and 20 Min after placing the last
           distal anastomoses.

      The results will be compared while using the parametric ANOVA test for normally distributed
      continuous data or the nonparametric Kruskal-Wallis/Wilcoxon-U test for categoric or
      inhomogeneous distributed continuous data.
    

Intervention name(s): Diprivan (propofol), Astra-Zeneca; Suprane (desflurane), Baxter
Intervention type(s): Drug; Drug
Intervention description(s): continuous intravenous infusion with a dose of 3-5 mg/kg/h; a vapor concentration of 3-7 vol% is maintained with use of vaporizer and under control of arterial blood pressure, heart rate, and BIS index.
Other intervention name(s): propofol; desflurane
Intervention MeSH terms: Propofol; Desflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: anesthesia intravenous; propofol; anesthesia inhalation; desflurane; heart surgery; coronary artery by-pass off-pump; hemodynamic processes; anesthesia