Is it possible to augment myocardial protection during cardiopulmonary bypass by administration of inhalational anesthetics?

Cover Page

Cite item

Abstract

Aim: To evaluate the possibility to augment myocardial protection with desflurane and sevoflurane by prolongation of their delivery into the oxygenator of the cardiopulmonary bypass (CPB) pump during surgical myocardial revascularization.

Materials and methods: This randomized prospective study included 75 patients with ischemic heart disease who underwent aortocoronary and mammary coronary bypass grafting with extracorporeal circulation from 2014 to 2017. The patients were allocated into the three study group by means of a  random number table generated by Statistica 10.0 software, depending on the anesthetic agent used: group 1, desflurane (n=30), group 2, sevoflurane (n=28), and group 3 (control), propofol (n=17). Desflurane and sevoflurane were delivered into the oxygenator during the artificial circulation. Hemodynamic parameters were assessed, such as cardiac index, total peripheral vascular resistance index, pulmonary artery wedge pressure. Changes in lactate, pyruvate, alanine, glutamate, glutamine, aspartate, asparagine, taurine, leucine, isoleucine and valine levels over time were assessed in blood taken from the heart coronary sinus before aortal clamping, before release of the clamp and after 30 minutes of reperfusion. During the first 24 hours post perfusion, we assessed the incidence of postperfusion heart failure (PPHF), duration of mechanical ventilation and duration of stay in the intensive care unit. Troponin I levels were measured at 12 and 24 hours after the intervention.

Results: There were no significant differences in the changes of the hemodynamic parameters over time in all the groups. The PPHF incidence and the course of the postoperative period were similar in all the groups. Irrespective on the type of the anesthesia, lactate and pyruvate levels increased during the CPB, with no significant differences between the groups, as well as the postoperative troponin I  levels at 12 and 24  hours after surgery. No differences between the groups were found for the changes of amino acid levels over time, except a  significant reduction of alanine levels during the aortal clamp in the group  3.

Conclusion: Prolongation of desflurane and sevoflurane delivery into the CPB pump oxygenator does not augment myocardial protection during myocardial revascularization surgery. 

About the authors

N. S. Molchan

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: johnwolver2@gmail.com

Nikolay S. Molchan - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022, Tel.: +7 (812) 338 60 77

Russian Federation

Yu. S. Polushin

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: polushin1@gmail.com
ORCID iD: 0000-0002-6313-5856

Yury S. Polushin -MD, PhD, Professor, Member of Russ. Acad. Sci., Head of Research Centre for Anesthesiology and Emergency Medicine, Head of the Chair of Anesthesiology and Resuscitation.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

A. A. Zhloba

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: zhloba@mail.spbnit.ru
ORCID iD: 0000-0003-0605-7617

Alexander A. Zhloba - MD, PhD, Professor, Head of the Biochemistry Department, Scientific and Research Centre.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

A. E. Kobak

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: kobak2006@yandex.ru

Andrey E. Kobak - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

A. A. Khryapa

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: alex_khryapa@yahoo.com

Aleksandr A. Khryapa - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation, Head of the Department of Anesthesiology, Research Centre for Anesthesiology and Emergency Medicine.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

References

  1. De Hert S, Vlasselaers D, Barbé R, Ory JP, Dekegel D, Donnadonni R, Demeere JL, Mulier J, Wouters P. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia. 2009;64(9):953–60. doi: 10.1111/j.13652044.2009.06008.x.
  2. Yildirim V, Doganci S, Aydin A, Bolcal C, Demirkilic U, Cosar A. Cardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study. Heart Surg Forum. 2009;12(1):E1– 9. doi: 10.1532/HSF98.20081137.
  3. Meco M, Cirri S, Gallazzi C, Magnani G, Cosseta D. Desflurane preconditioning in coronary artery bypass graft surgery: a double-blinded, randomised and placebo-controlled study. Eur J Cardiothorac Surg. 2007;32(2):319–25. doi: 10.1016/j.ejcts.2007.05.005.
  4. McMullan V, Alston RP, Tyrrell J. Volatile anaesthesia during cardiopulmonary bypass. Perfusion. 2015;30(1):6–16. doi: 10.1177/0267659114531314.
  5. Likhvantsev VV, Landoni G, Levikov DI, Grebenchikov OA, Skripkin YV, Cherpakov RA. Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial. J Cardiothorac Vasc Anesth. 2016;30(5):1221– 7. doi: 10.1053/j.jvca.2016.02.030.
  6. Kapoor P, Mandal B, Chowdhury U, Singh S, Kiran U. Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: Early indicator of morbidity. J Anaesthesiol Clin Pharmacol. 2011;27(2):225–32. doi: 10.4103/0970-9185.81819.
  7. Молчан НС, Полушин ЮС, Жлоба АА, Кобак АЕ, Хряпа АА. Влияние анестезии с пролонгированным использованием десфлурана и севофлурана на этапе искусственного кровообращения на функцию сердца при операциях аортокоронарного шунтирования. Вестник анестезиологии и реаниматологии. 2017;14(4):23–31. doi: 10.21292/20785658-2017-14-4-23-31.
  8. Молчан НС, Жлоба АА, Полушин ЮС, Шиганов МЮ, Кобак АЕ, Хряпа АА, Третьякова ИВ. Влияние концентрации пирувата в крови на развитие постперфузионной сердечной недостаточности при операции реваскуляризации миокарда в условиях искусственного кровообращения. Вестник анестезиологии и реаниматологии. 2016;13(6):23–30. doi: 10.21292/2078-5658-2016-13-6-23-30.
  9. Полушин ЮС, Молчан НС, Жлоба АА, Шиганов МЮ, Кобак АЕ, Хряпа АА. Доперфузионный уровень лактата и лактат-пируватного соотношения как критерий прогноза развития постперфузионной сердечной недостаточности при операции реваскуляризации миокарда в условиях искусственного кровообращения. Вестник анестезиологии и реаниматологии. 2016;13(4):19–28. doi: 10.21292/2078-5658-2016-13-4-1.
  10. Schaffer SW, Jong CJ, Ramila KC, Azuma J. Physiological roles of taurine in heart and muscle. J Biomed Sci. 2010;17 Suppl 1:S2. doi: 10.1186/1423-0127-17-S1-S2.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2019 Molchan N.S., Polushin Y.S., Zhloba A.A., Kobak A.E., Khryapa A.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies