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Late pharmacologic conditioning with volatile anesthetics after cardiac surgery

Marc P Steurer123, Martina A Steurer124, Werner Baulig1, Tobias Piegeler127, Martin Schläpfer12, Donat R Spahn1, Volkmar Falk5, Pamela Dreessen1, Oliver M Theusinger1, Edith R Schmid6, David Schwartz7, Thomas A Neff8 and Beatrice Beck-Schimmer12*

Author Affiliations

1 Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

2 Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland

3 Department of Anesthesiology and Perioperative Care, University of California at San Francisco, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, USA

4 Pediatric Critical Care, Department of Pediatrics, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA

5 Department of Cardiac Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

6 Division of Cardiac Anaesthesia, Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

7 Department of Anesthesiology, University of Illinois at Chicago, 1740 West Taylor Street, Suite 3200W, MC 515, Chicago, IL 60612, USA

8 Department of Anaesthesiology, Intensive Care and Emergency Medicine, Cantonal Hospital, Postfach, CH-8596 Muensterlingen, Switzerland

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Critical Care 2012, 16:R191  doi:10.1186/cc11676

Published: 14 October 2012

Abstract

Introduction

The aim of this randomized controlled trial was to investigate whether volatile anesthetics used for postoperative sedation have any beneficial effects on myocardial injury in cardiac surgery patients after on-pump valve replacement.

Methods

Anesthesia was performed with propofol. After arrival in the intensive care unit (ICU), 117 patients were randomized to be sedated for at least 4 hours with either propofol or sevoflurane. Sevoflurane was administered by using the anesthetic-conserving device. Troponin T, creatine kinase, creatine kinase from heart muscle tissue, myoglobin, and oxygenation index were determined on arrival at the ICU, 4 hours after sedation, and in the morning of the first postoperative day (POD1). Primary end points were cardiac injury markers on POD1. As secondary end points oxygenation, postoperative pulmonary complications, and ICU and hospital stay were documented.

Results

Fifty-six patients were analyzed in the propofol arm, and 46 patients in the sevoflurane arm. Treatment groups were comparable with regard to patient demographics and intraoperative characteristics. Concentration of troponin T as the most sensitive marker for myocardial injury at POD1 was significantly lower in the sevoflurane group compared with the propofol group (unadjusted difference, -0.4; 95% CI, -0.7 to -0.1; P < 0.01; adjusted difference, -0.2; 95% CI, -0.4 to -0.02; P = 0.03, respectively).

Conclusions

The data presented in this investigation indicate that late postconditioning with the volatile anesthetic sevoflurane might mediate cardiac protection, even with a late, brief, and low-dose application.

Trial registration

ClinicalTrials.gov: NCT00924222.