Hemmerling T, Olivier J-F, Le N, Prieto I, Bracco D
McGill University Health Center, Hôtel-Dieu Hospital, Cardiac Surgery Department, Montréal, Québec, Canada.
Eur J Anaesthesiol. 2008 Mar;25(3):230-6. doi: 10.1017/S0265021507002608. Epub 2007 Sep 26.
Volatile anaesthetics have gained more popularity recently due to the potential for cardiac protection. Ultra-fast-track anaesthesia implies the immediate extubation after cardiac surgery. The purpose of this prospective randomized double-blind controlled study is to compare the cardioprotective effects of sevoflurane and isoflurane in off-pump cardiac bypass surgery.
Forty patients undergoing elective off-pump cardiac bypass surgery with high thoracic epidural analgesia and immediate extubation at the end of surgery were randomized into two groups. During surgery, anaesthesia was provided with either 1 minimum alvelolar anaesthetic concentration of sevoflurane or 1 minimum alvelolar anaesthetic concentration of isoflurane. Troponin-T, creatine kinase-MB, left ventricular wall motion anomalies, time to extubation, respiratory functions and haemodynamic parameters were compared between the two groups by analysis of variance.
All patients were successfully extubated in the operating theatre with minimal postoperative pain. Serial creatine kinase-MB and troponin-T concentrations were not significantly different between the two volatile agents. Haemodynamic stability throughout surgery and contractility was not different between groups. However, extubation time was significantly shorter with sevoflurane (10 +/- 5 min) compared to isoflurane (18 +/- 4 min).
This study indicates that during off-pump cardiac bypass surgery, sevoflurane and isoflurane provide the same ischaemic cardioprotective effects. There is no difference for heart contractility and haemodynamic values during and after off-pump cardiac bypass surgery between the two agents. Sevoflurane allows a more rapid recovery from anaesthesia, but this does not translate into better pulmonary function or haemodynamics. Both agents are similar in ultra-fast-track off-pump cardiac bypass surgery.
由于具有心脏保护作用的潜力，挥发性麻醉剂近来越来越受到欢迎。超快通道麻醉意味着心脏手术后立即拔管。这项前瞻性随机双盲对照研究的目的是比较七氟醚和异氟醚在非体外循环冠状动脉搭桥手术中的心脏保护作用。
40例行择期非体外循环冠状动脉搭桥手术且术中采用高位胸段硬膜外镇痛并于手术结束时立即拔管的患者被随机分为两组。手术期间，一组使用1个最低肺泡有效浓度的七氟醚进行麻醉，另一组使用1个最低肺泡有效浓度的异氟醚进行麻醉。通过方差分析比较两组患者的肌钙蛋白T、肌酸激酶同工酶MB、左心室壁运动异常、拔管时间、呼吸功能和血流动力学参数。
所有患者均在手术室成功拔管，术后疼痛轻微。两种挥发性麻醉剂的系列肌酸激酶同工酶MB和肌钙蛋白T浓度无显著差异。两组在整个手术过程中的血流动力学稳定性和收缩性无差异。然而，与异氟醚（18±4分钟）相比，七氟醚组的拔管时间显著缩短（10±5分钟）。
本研究表明，在非体外循环冠状动脉搭桥手术中，七氟醚和异氟醚具有相同的缺血性心脏保护作用。两种药物在非体外循环冠状动脉搭桥手术期间及术后的心脏收缩性和血流动力学值方面无差异。七氟醚可使患者从麻醉中更快恢复，但这并未转化为更好的肺功能或血流动力学。在超快通道非体外循环冠状动脉搭桥手术中，两种药物相似。
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