Mroziński Paweł, Lango Romuald, Biedrzycka Aleksandra, Kowalik Maciej Michał, Pawlaczyk Rafał, Rogowski Jan
Anaesthesiol Intensive Ther. 2014 Jan-Mar;46(1):4-13. doi: 10.5603/AIT.2014.0002.
Several studies have highlighted that volatile anaesthetics improve myocardial protection in cardiopulmonary bypass coronary surgery. However, the haemodynamic effect of desflurane in off-pump coronary surgery has not been clarified yet. Our study hypothesis was that desflurane-fentanyl anaesthesia could decrease myocardial injury markers and improve haemodynamics compared to propofol-fentanyl in patients undergoing off-pump coronary surgery.
Prospective, randomised open-lable study. Sixty elective patients with left ventricular ejection fraction above 30% received either desflurane (group D, n = 32) or propofol (group P, n = 28), in addition to fentanyl and vecuronium bromide anaesthesia for off-pump coronary surgery. Assessment of haemodynamic function included thermodilution continuous cardiac output and right ventricular end diastolic volume.
No significant differences in cardiac output, stroke volume and mean arterial pressure were noted between groups. The only observed difference in haemodynamic profile was that group D demonstrated improved stability, expressed as left ventricular stroke work index (LVSWI). Decrease in LVSWI after performing distal anastomoses was smaller in D compared to P (median value: -14.3 and -19.8 [g m m⁻² beat⁻¹]), respectively (P = 0.029). Oxygen uptake index (VO₂I) and oxygen extraction ratio (OER) after skin incision were lower in D, while blood lactate concentration was slightly higher after surgery in D compared to P. The groups did not differ with respect to CK-MB and troponin I concentration.
This study demonstrated no difference between desflurane and propofol anaesthesia for off-pump coronary surgery in major haemodynamic parameters, as well as in myocardial injury markers and the long-term outcome. However, the study indicated that desflurane might accelerate recovery of myocardial contractility, as assessed by LVSWI. Lower oxygen uptake and elevated lactate under desflurane anaesthesia indicated a discrete shift towards anaerobic metabolism.
NCT00528515 (http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1).
多项研究强调挥发性麻醉剂可改善体外循环冠状动脉手术中的心肌保护。然而，地氟醚在非体外循环冠状动脉手术中的血流动力学效应尚未明确。我们的研究假设是，在接受非体外循环冠状动脉手术的患者中，与丙泊酚 - 芬太尼相比，地氟醚 - 芬太尼麻醉可降低心肌损伤标志物并改善血流动力学。
前瞻性、随机开放标签研究。60例左心室射血分数高于30%的择期患者，除接受芬太尼和维库溴铵麻醉用于非体外循环冠状动脉手术外，分别接受地氟醚（D组，n = 32）或丙泊酚（P组，n = 28）。血流动力学功能评估包括热稀释连续心输出量和右心室舒张末期容积。
两组之间的心输出量、每搏输出量和平均动脉压无显著差异。血流动力学特征中唯一观察到的差异是，D组表现出更好的稳定性，以左心室每搏功指数（LVSWI）表示。与P组相比，D组在进行远端吻合术后LVSWI的下降更小（中位数分别为 -14.3和 -19.8 [g m m⁻² beat⁻¹]）（P = 0.029）。D组皮肤切开后的氧摄取指数（VO₂I）和氧摄取率（OER）较低，而术后D组的血乳酸浓度略高于P组。两组在肌酸激酶同工酶（CK-MB）和肌钙蛋白I浓度方面无差异。
本研究表明，地氟醚和丙泊酚麻醉在非体外循环冠状动脉手术的主要血流动力学参数、心肌损伤标志物及长期预后方面无差异。然而，该研究表明，以LVSWI评估，地氟醚可能加速心肌收缩力的恢复。地氟醚麻醉下较低的氧摄取和升高的乳酸表明向无氧代谢有轻微转变。
NCT00528515（http://www.clinicaltrials.gov/ ct2/show/NCT00528515?term = NCT00528515&rank = 1）。
Zotero 插件