Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Apr;95(17):e3424.
doi: 10.1097/MD.0000000000003424.

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery: A Prospective, Randomized Pilot Study

Zhaoxia Tan  1 , Li Zhou, Zhen Qin, Ming Luo, Hao Chen, Jiyue Xiong, Jian Li, Ting Liu, Lei Du, Jing Zhou
Affiliations
Randomized Controlled Trial

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery: A Prospective, Randomized Pilot Study

Zhaoxia Tan et al. Medicine (Baltimore). 2016 Apr.

Abstract

Patients undergoing cardiac surgery often experience abnormal bleeding, due primarily to cardiopulmonary bypass (CPB)-induced activation of platelets. Sevoflurane may inhibit platelet activation, raising the possibility that administering it during CPB may reduce blood loss.Patients between 18 and 65 years old who were scheduled for cardiac surgery under CPB at our hospital were prospectively enrolled and randomized to receive intravenous anesthetics alone (control group, n = 77) or together with sevoflurane (0.5-1.0 vol/%) from an oxygenator (sevoflurane group, n = 76). The primary outcome was postoperative blood loss, the secondary outcome was postoperative need for blood products.Volume of blood loss was 48% lower in the sevoflurane group than the control group at 4 hours after surgery, and 33% lower at 12 hours after surgery. Significantly fewer patients in the sevoflurane group lost >700 mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result, the sevoflurane group received significantly smaller volumes of packed red blood cells (1.25 ± 2.36 vs 2.23 ± 3.75 units, P = 0.011) and fresh frozen plasma (97 ± 237 vs 236 ± 344 mL, P = 0.004). Thus the sevoflurane group was at significantly lower risk of requiring complex blood products after surgery (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17-0.68, P = 0.002).Sevoflurane inhalation from an oxygenator during CPB may reduce blood loss and need for blood products after cardiac surgery.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient selection, randomization, and analysis.
FIGURE 2
FIGURE 2
Postoperative outcomes in patients who received inhaled sevoflurane or not during cardiopulmonary bypass. (A) Chest tube drainage, (B) packed red blood cell transfusion, and (C) fresh frozen plasma transfusion. “In OR after CPB” refers to the interval between when patients were weaned off CPB and when they arrived in the intensive ICU. CPB = cardiopulmonary bypass, ICU = intensive care unit, OR = operation room.
FIGURE 3
FIGURE 3
Changes in hemoglobin levels (A) and platelet counts (B) between baseline and after cardiac surgery in patients who received inhaled sevoflurane or not during cardiopulmonary bypass. ICU = intensive care unite.
FIGURE 4
FIGURE 4
Proportions of patients receiving transfusions of 0 to 4 blood products during and after cardiac surgery. Patients had been randomized to receive inhaled sevoflurane or not during cardiopulmonary bypass. Blood products included fresh frozen plasma, platelets, prothrombin complex, fibrinogen, and cryoprecipitate.
See this image and copyright information in PMC

References

    1. Christensen MC, Krapf S, Kempel A, et al. Costs of excessive postoperative hemorrhage in cardiac surgery. J Thorac Cardiovasc Surg 2009; 138:687–693. - PubMed
    1. Karkouti K, Wijeysundera DN, Beattie WS, et al. Reducing Bleeding in Cardiac Surgery (RBC) Research Group. Variability and predictability of large-volume red blood cell transfusion in cardiac surgery: a multicenter study. Transfusion 2007; 47:2081–2088. - PubMed
    1. Karkouti K, Wijeysundera DN, Yau TM, et al. The independent association of massive blood loss with mortality in cardiac surgery. Transfusion 2004; 44:1453–1462. - PubMed
    1. Koch CG, Li L, Duncan AI, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34:1608–1616. - PubMed
    1. Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116:2544–2552. - PubMed

Publication types