The Effect of Desflurane on Myocardial Function in Patients Undergoing Coronary Artery Bypass Grafting

Study Overview
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Brief Summary
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This study is to assess the effect of desflurane on myocardial function in patents who underwent coronary artery bypass grafting.

Detailed Description
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Desﬂurane, one of the third-generation inhaled anesthetics, is introduced in clinical practice in 1990s. Decades of clinical use has provided evidence for desﬂurane's safe and efﬁcacious use as a general anesthetic. Compared with other volatile anesthestics, it has several characteristics: lower blood and lipid solubility, more stable in vitro and the lowest in vivo metabolism. Its particular low fat solubility properties promote rapid equilibration and rapid elimination at the end of anesthesia which reduces slow compartment accumulation and promotes predictable emergence, early extubation, and the ability to rapidly transfer patients from the operating room to the recovery unit. In addition, several investigations found that patients with desflurane anesthesia recovered their protective airway reﬂexes and awakened to a degree sufﬁcient to minimize the stay in the high dependency recovery area. A burgeoning body of investigations has shown that desflurane can directly act on myocardial and vascular functions. Desflurane has coronary vasodilative effects in in situ canine hearts which is comparable to sevoflurane does. Although it is controversial regarding to the effect of desflurane on myocardial excitation-contraction coupling and electrophysiologic behavior, a elaborated study found desflurane induced a positive inotropic effect in rat myocardium in vitro compared with isoflurane. A recent study suggested that desflurane decreased right ventricular contractility much less and maintained the right over left pressures ratio at more favorable values compared with sevoflurane. Furthermore, substantial investigations found that clinically relevant concentration desflurane preconditioning or postconditioning could protect myocardium from ischemia-reperfusion in mammalian animal models or isolated human cardiac tissues. However, it is unclear whether desflurane can provide protection for patients with coronary artery disease. Therefore, this study is designed to investigate the effect of desflurane on myocardial function in patents who underwent coronary artery bypass grafting.

Official Title
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The Effect of Desflurane on Myocardial Function in Patients Undergoing Coronary Artery Bypass Grafting

Conditions
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Coronary Artery Bypass Graft Redo, General Anesthetic Drug Adverse Reaction

Intervention / Treatment
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* Drug: Desflurane
* Drug: propofol
* Drug: sufentanil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Diagnosed with CAD 2. ASAⅡ～Ⅲ - Exclusion Criteria: Left ventricular ejection fraction <40% Left ventricular aneurysm Acute myocardial infarction in latest two weeks, atrial fibrillation Associated vascular diseases, severe systemic diseases involving the renal and hepatic systems Respiratory disease( forced vital capacity less than 50% of predicted values ) Preoperative left bundle branch block -

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Desflurane<br>desflurane (7%-8% end-tidal concentration), sufentanil (TCI: 2-3 ng/ml) and vecuronium (0.04mg/kg/h) | Drug: Desflurane<br>* desflurane (7%-8% end-tidal concentration)<br>* Other names: serial numbers and code names：not available yet;Drug: sufentanil<br>* TCI: 2-3 ng/ml during the duration of surgery, an expected average of 4 hours<br>* Other names: serial numbers and code names: not available yet;|
| Active Comparator: propofol<br>intravenous administration of sufentanil (1μg/kg), etomidate(0.3mg/kg) and vecuronium (0.08mg/kg). The anesthesia is maintained with propofol (TCI:3.5-4.0μg/min), sufentanil (TCI: 2-3 ng/ml) and vecuronium (0.04mg/kg/h). | Drug: propofol<br>* propofol (TCI:3.5-4.0μg/min)<br>* Other names: serial numbers and code names：not available yet;Drug: sufentanil<br>* TCI: 2-3 ng/ml during the duration of surgery, an expected average of 4 hours<br>* Other names: serial numbers and code names: not available yet;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum Concentration of cTnI | at the begingineg of the surgery,immediately after surgery,4 hours after the surgery, 8 hours after the surgery, 12 hours after the surgery, 24 hours after the surgery | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Continuous Monitoring of ECG | participants will be followed for the duration of hospital stay, an expected average of 5 weeks.ECG incidents such as tachycardia, bradycardia, premature ventricualr contraction and ST segment changes will be monitored and recorded. | participants will be followed for the duration of hospital stay, an expected average of 5 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Desflurane, myocardial function, Coronary Artery Bypass Surgery