The use of a volatile anesthetic regimen protects against acute normovolemic hemodilution induced myocardial depression in patients with coronary artery disease

<b>Background:</b> Previous studies indicated that acute normovolemic hemodilution (ANH) was associated with a depression of myocardial function in coronary surgery patients with baseline heart rate faster than 90 bpm. It was suggested that this phenomenon could be explained by the occurrence of myocardial ischemia. In the present study, we hypothesized that the cardioprotective properties of a volatile anesthetic regimen might protect against the ANH related myocardial functional impairment. <b> Materials and Methods:</b> Forty elective coronary surgery patients with baseline heart rate faster than 90 bpm were randomly allocated to receive different anesthetic regimens. Group A (n = 20) received midazolam-based anesthesia. Group B (n = 20) received a sevoflurane-based anesthesia. Five-lead electrocardiogram, pulse oximetry, capnography, radial arterial pressure, and Swan Ganz continuous thermodilution cardiac output via right internal jugular vein were monitored. Measurements were obtained before and after ANH. Data were compared using paired t test. All data were expressed as mean &#x00B1; SD. Data were considered significant if <i> P</i> &lt; 0.05. <b> Results:</b> After ANH, systemic vascular resistance was slightly decreased in group A while there was a significant decrease in group B. In group A, cardiac output was slightly decreased from 5.07&#x00B1;1.17 l/min to 5.02&#x00B1;1.28 l/min after ANH, whereas in group B, cardiac output was significantly increased from 4.84&#x00B1;1.21 l/min to 6.02&#x00B1;1.28 l/min after ANH. <b> Conclusion:</b> In coronary surgery patients, with baseline heart rate faster than 90 bpm, anesthesia with sevoflurane during ANH was associated with an improvement in myocardial function after ANH, which was not present in patients anesthetized with midazolam

Continuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass

This study compared cardiac output measured with an arterial pressure-based cardiac output measurement system and a thermodilution cardiac output measurement system. We studied 36 patients undergoing cardiac surgery with cardiopulmonary bypass. Simultaneous arterial pressure-based and thermodilution cardiac output measurements were compared before and after cardiopulmonary bypass, and after phenylephrine administration. Bland-Altman analysis showed good overall agreement between the two methods. Bias (limits of agreement) before and after cardiopulmonary bypass were - 0.21 (- 2.97-2.55) lxmin(-1) and 0.01 (- 3.79-3.81) lxmin(-1), respectively. Phenylephrine administration decreased thermodilution cardiac output by a mean (SD) of 11 (16)% and increased arterial pressure-based cardiac output by 55 (34)%. We conclude that arterial pressure-based cardiac output and thermodilution cardiac output measurement systems yield comparable results during cardiac surgery with cardiopulmonary bypass. However, after phenylephrine administration, the two measurement systems provided opposing result

Effects of sevoflurane on biomechanical markers of hepatic and renal dysfunction after coronary artery surgery

OBJECTIVE: The purpose of this study was to compare the effects of a total intravenous and a volatile anesthetic regimen on biochemical markers of hepatic and renal dysfunction after coronary artery surgery. DESIGN: Prospective, double-blind, randomized clinical study. SETTING: University hospital, single institutional. PARTICIPANTS: Three hundred twenty patients undergoing elective coronary artery surgery were divided into 2 different anesthetic protocols: propofol group (n = 160) and sevoflurane group (n = 160). INTERVENTIONS: Hemodynamic data were registered before the start of surgery, before the start of CPB, 15 minutes after the end of CPB, at arrival in the intensive care unit, and 6 and 12 hours after arrival in the intensive care unit. Serum glutamic oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), serum lactate dehydrogenase (LDH), and serum creatinine concentrations were measured before surgery, at arrival in the intensive care unit, and after 6, 12, 24, and 48 hours. MEASUREMENTS AND MAIN RESULTS: Postoperative levels of serum SGOT, SGPT, and LDH increased transiently in both anesthetic groups, but the increase was significantly lower in the sevoflurane group compared with the propofol group. Creatinine levels remained largely unchanged in both groups. CONCLUSION: Postoperative biochemical markers of hepatic dysfunction were lower with a sevoflurane-based anesthetic regimen in patients undergoing coronary artery surgery with cardiopulmonary bypas