INFLUENCE OF SEVOFLURANE, ISOFLURANE AND PROPOFOL ON THE CARDIOVASCULAR SYSTEM, OXYGEN TRANSPORT FUNCTION OF BLOOD, BODY ENERGY CONSUMPTION DURING CARDIAC SURGICAL OPERATIONS IN ADULTS
Introduction. Total intravenous anaesthesia and inhalation anaesthesia are the traditional methods of anaesthesia in cardiac surgery. However, there are few studies assessing the effectiveness of surgical aggression protection in cardiac surgery.
Objectives. To study the effectiveness of body protection against surgical aggression by TIVA and inhalational anaesthesia in cardiac surgery.
Materials and methods. The study included data from the examination and treatment of 87 patients. All patients underwent autovenous coronary artery bypass grafting and/or mammary coronary artery bypass grafting, mitral and aortic valve replacement/plasty under cardiopulmonary bypass (CPB).
The patients were divided into 2 groups according to the type of disease: First (1) – group with coronary heart disease. The second (2) group with valvular heart disease. There were 65 patients in the first group, 22 patients in the second group. Both groups were divided into 3 subgroups according to the type of anesthesia: those who received anesthesia with propofol, with sevoflurane, with isoflurane.
Induction anesthesia for all patients in both groups was performed with fentanyl at a dose of 5-7 mcg/kg, ketamine 1.5-2 mg/kg and propofol 1-1.5 mg/kg, divided intravenously. For muscle relaxation, pipecuronium bromide was used in all patients at a dose of 0.04-0.07 mg/kg. To maintain anesthesia in group 1, propofol was used as an anesthetic at a dose of 4-6 mg/kg/h intravenously on a perfusor. In group 2, sevoflurane was used as an anesthetic at a dose of 1.7-1.9 MAC. In group 3, isoflurane was used as an anesthetic at a dose of 1.1-1.2 MAC.
Statistical analysis was carried out using one-way analysis of variance and the Kruskal-Wallis test. We also conducted a correlation analysis using the Pearson and Spearman method to determine the significance of the relationship between the cardiac index and oxygen consumption, as well as energy expenditure.
Result. Anaesthesia with propofol was accompanied by an increase in cardiac index of 2.3±0.6 l/min/m2 to 2.7±0.4 l/min/m2, whereas with isoflurane there was a non-significant decrease in cardiac index to 2.1±0.5 l/min/m2. Anaesthesia with propofol also increased oxygen consumption from 115.2±38.2 ml/min/m2 to 121.7±22.7 ml/min/m2.
Conclusion. Despite the high use of muscle relaxants and fentanyl, hemodynamic instability and prolonged ventilator stays were observed in the propofol group.
Bekzat A. Bayterek1, https://orcid.org/0000-0002-7124-9175
Alibek Kh. Mustafin1, https://orcid.org/0009-0009-6461-7185
Marat K. Syzdykbayev2, https://orcid.org/0000-0002-0561-4111
1 NJSC "Astana Medical University", Department of Anesthesiology and Reanimatology No. 2,
Astana, Republic of Kazakhstan;
2 NJSC «Semey Medical University», Department of Hospital Surgery, Anesthesiology and Reanimatology, Semey, Republic of Kazakhstan.
1. Ariyo P., Abernathy J.H., Hensley. N.B. Roleof Value-Added Care by Cardiothoracic Anesthesiology and Impact on Outcomes AfterCardiacSurgery // Seminars in Cardiothoracic and Vascular Anesthesia. Volume 26, Issue 3, P.173–178. September 2022. doi:10.1177/10892532211048953
2. AhnJin H., Hyun J.A., Jae-Woo Y. Total Intravenous Anesthesia Maintained the Degree of Pre-Existing Mitral Regurgitation Better than Isoflurane Anesthesia in Cardiac Surgery: A Randomized Controlled Trial // J. Clin. Med.2019,8(8), 1104. doi:10.3390/jcm8081104
3. Ball L., Federico C., Paolo P. Postoperative complications of patients undergoing cardiac surgery // CurrOpin Crit Care.2016 Aug. 22(4):386-92.doi:10.1097/MCC.0000000000000319.
4. Chiu-Fen Y., Michael Yu-Chih Ch., Tsung-I Ch. Ching-Feng Ch. Dose-dependent effects of isoflurane on cardiovascular function in rats // Tzu Chi Medical Journal. Volume 26, Issue 3, September 2014, р.р. 119-122. https://www.tzuchi.com.tw/medjnl/files/2014/vol-26-3/2014-26-3-119-122.pdf.
5. Kato R., Foëx P. Myocardial protection by anesthetic agents against ischemia-reperfusion injury: An update for anesthesiologists //Canadian Journal of Anesthesia. Open AccessVolume 49, Issue 8, Pages 777 – 791. October 2002. doi:10.1007/BF03017409.
6. Kunst G., Milojevic M., Boer C., De Somer F.M., Gudbjartsson T., van den Goor J., EACTS/EACTA/EBCP Committee Reviewers 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery // Br. J. Anaesth. 2019. 123:713–757. [PubMed] [Google Scholar]
7. Landoni G., Biondi-Zoccai G.G., et al. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials // J Cardiothorac Vasc Anesth. 2007. 21(4):502–11. doi:10.1053/j.jvca.2007.02.013.
8. Landoni G., OlivieroF.,Giorgio T. Cardiac Protection by Volatile Anaesthetics: A Review. Current Vascular Pharmacology. Volume 6, Issue 2, 2008 рр.108 - 111. doi:10.2174/157016108783955284.
9. Landoni G., Greco T., Biondi-Zoccai G., Neto C.N., Febres D., Pintaudi M. et al.Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery // Br J Anaesth. 2013. 111(6):886–96. doi:10.1093/bja/aet231.
10. Landoni G., Biondi-Zoccai G.L., Zangrillo A. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials // Journal of Cardiothoracic and Vascular Anesthesia, V.21, №4, pp.502–511, 2007. doi:https://doi.org/10.1053/j.jvca.2007.02.013
11. Landoni G., Lomivorotov V.V., Nigro Neto C., Monaco F., Pasyuga V.V., Bradic N., Zangrillo A. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery // N. Engl. J. Med. 2019;380:1214–1225. doi:10.1056/NEJMoa1816476. [PubMed] [CrossRef] [Google Scholar]
12. Pisano A.,MicheleT.,AndreyY.,Giovanni L. The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review // J CardiothoracVascAnesth.2021 Mar. 35(3):711-729. doi: 10.1053/j.jvca.2020.03.054.
13. Symons J., Myles P. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis // Br J Anaesth. 2006. 97(2):127–36. doi: 10.1093/bja/ael149.
14. Shuangqin W., Yuguang X.U., et al. Effect of sevoflurane inhalation anesthesia on postoperative extubation time and major adverse cardiovascular events incidence in patients undergoing mitralvalvereplacement // Journal of Chinese Physician. V.22, Issue 4, Pages 535-538 and 54320 April 2020. DOI:10.3760/cma.j.cn431274-20190118-00036.
15. Sousa-Uva* M., Head S.J., et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery // Eur. J. Cardiothorac. Surg. 2018;53:5–33. doi:10.1093/ejcts/ezx314. [PubMed] [CrossRef] [Google Scholar]
16. StraarupTh.S., Hausenloy D.J., Rolighed L., Jens K. Cardiac troponins and volatile anaesthetics in coronary artery bypass graft surgery. A systematic review, meta-analysis and trial sequential analysis // European Journal of Anaesthesiology:June 2016, Volume 33. Issue 6, p 396-407. doi:10.1097/EJA.0000000000000397.
17. Tanaka K., Kersten J.R, Riess M.L. Opioid-induced cardioprotection //Curr Pharm Des. 2014. 20(36):5696–705.https://doi.org/10.2174/1381612820666140204120311
18. Uhlig C., Bluth T., Schwarz K.Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis // Anesthesiology, vol.124, no.6, pp. 1230–1245, 2016. https://doi.org/10.1097/ALN.0000000000001120.
19. Wit F.,van Vliet A.L.,de Wilde R.B.,Jansen J.R.,Vuyk J.,Aarts L.P.,de Jonge E., Veelo D.P., Geerts B.F. The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistances // Br J Anaesth.2016 Jun. 116(6):784-9.doi:10.1093/bja/aew126.
20. Yu C.H., Beattie W.S. The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis // Can J Anaesth. 2006. 53(9):906–18. doi:10.1007/BF03022834.
21. Yu C.H., Beattie W.S. The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis // Canadian Journal of Anesthesia, vol. 53, no. 9, pp. 906–918, 2006. https://link.springer.com/article/10.1007/BF03022834
22. Zaugg M., Lucchinetti E., Behmanesh S., Clanachan A.S. Anesthetic cardioprotection in clinical practice from proof-of-concept to clinical applications // Curr Pharm Des. 2014. 20(36):5706–26.https://doi.org/10.2174/1381612820666140204120829.
23. Writing Committee Members. Hillis L.D., et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines // Circulation. 2011. 124:2610–2642. [PubMed] [Google Scholar]
Number of Views: 53
Category of articles:
Original articles
Bibliography link
Bayterek B.A., MustafinA.Kh., Syzdykbayev M.K. Influence of Sevoflurane, Isoflurane and Propofol on the cardiovascular system, oxygen transport function of blood, body energy consumption during cardiac surgical operations in adults // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 5, pp. 83-90. doi 10.34689/SH.2023.25.5.011Related publications:
ANALYSIS OF CLINICAL AND DEMOGRAPHIC INDICATORS OF PATIENTS WITH PARKINSON'S DISEASE IN THE SOUTHERN REGION OF KAZAKHSTAN
A COMPARATIVE STUDY OF DRUG POLICY REGARDING ORPHAN DISEASES IN THE USA, THE EUROPEAN UNION, AND THE REPUBLIC OF KAZAKHSTAN
MUTATIONS IN CARDIAC ION CHANNEL GENES IN KAZAKHSTANI PATIENTS WITH LONG QT SYNDROME
GENETIC FEATURES OF CONGENITAL DYSFUNCTION OF THE ADRENAL CORTEX CAUSED BY 21-HYDROXYLASE DEFICIENCY IN PERSONS OF KAZAKH NATIONALITY
NON-MOTOR SYMPTOMS IN PARKINSON'S DISEASE USING THE EXAMPLE OF AKTOBE PATIENTS