INFLUENCE OF SEVOFLURANE, ISOFLURANE AND PROPOFOL ONTHE CARDIOVASCULAR SYSTEM, OXYGEN TRANSPORT FUNCTIONOF BLOOD, BODY ENERGY CONSUMPTION DURING CARDIACSURGICAL OPERATIONS IN ADULTS

Abstract

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.