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
. 2017 Aug 11;17(1):104.
doi: 10.1186/s12871-017-0397-0.

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

Yunlong Zhang  1 , Wendong Lin  2 , Sheliang Shen  1 , Hongfa Wang  1 , Xiaona Feng  3 , Jiehao Sun  4
Affiliations
Randomized Controlled Trial

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

Yunlong Zhang et al. BMC Anesthesiol. .

Abstract

Background: It is skeptical about cardioprotective property of sevoflurane in patients undergoing noncardiac surgery, especially in the elderly patients with coronary heart disease. We hypothesized that long duration of sevoflurane inhalation in noncardiac surgery could ameliorate myocardial damage in such patients.

Methods: This was a randomized, prospective study. One hundred twenty-one elderly patients with coronary heart disease were randomly allocated into two groups. Maintenance of anesthesia was achieved by sevoflurane inhalation (Group S) or propofol-remifentanil respectively (Group PR). Serum cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) were measured before anesthesia induction (T0), 8 h (T1) and 24 h (T2) after anesthesia respectively. The perioperative cardiac output, complications and postoperative 3-month follow-up from end of surgery were recorded.

Results: Between the two groups, there were no statistical differences in the values of cTnI and BNP during the study. However, The area under the curve of cTnI values over 24 h after operation was less in Group S. Group PR had lower cardiac output and consumed more amount of phenylephrine during the study (P < 0.05).

Conclusions: Compared with the group PR, sevoflurane had no benefit in the myocardial protection for the elderly patients with CHD. However, Sevoflurane showed advantage in maintaining hemodynamic stability during the operative period.

Trial registration: Chinese Clinical Trial Registry, ChiCTR-IPR-16008871 , 21 July 2016.

Keywords: BNP; Myocardial injury; Sevoflurane; cTnI.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The experimental protocol was approved by the institutional research ethics committee of Zhejiang Provincial People’s Hospital (Protocol Number: 2104KY060). All of the patients involved in the research study have given their written informed consent for participation.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of participants through the study
Fig. 2
Fig. 2
Box plots of cTnI and BNP values during the trial. (a) cTnI values during the trial (b) BNP values during the trial. Values are presented as median (square mark) with 25th to 75th percentiles (box), mean (horizontal bar in the box), 10th to 90th percentiles (whiskers) and upper, low limit (star shape)
Fig. 3
Fig. 3
Cardiac output after anesthesia induction. S: Group sevoflurane. PR: Group propofol and remifentanil. Cardiac output are presented as Median. *p < 0.01 versus Group PR
See this image and copyright information in PMC

References

    1. Alcock RF, Kouzios D, Naoum C, Hillis GS, Brieger DB. Perioperative myocardial necrosis in patients at high cardiovascular risk undergoing elective non-cardiac surgery. Heart. 2012;98:792–798. doi: 10.1136/heartjnl-2011-301577. - DOI - PubMed
    1. Gao S, Yang Z, Shi R, Xu D, Li H, Xia Z, et al. Diabetes blocks the cardioprotective effects of sevoflurane postconditioning by impairing Nrf2/Brg1/HO-1 signaling. Eur J Pharmacol. 2016;779:111–121. doi: 10.1016/j.ejphar.2016.03.018. - DOI - PubMed
    1. Lemoine S, Tritapepe L, Hanouz JL, Puddu PE. The mechanisms of cardio-protective effects of desflurane and sevoflurane at the time of reperfusion: anaesthetic post-conditioning potentially translatable to humans? Br J Anaesth. 2016;116:456–475. doi: 10.1093/bja/aev451. - DOI - PubMed
    1. Kunst G, Klein AA. Peri-operative anaesthetic myocardial preconditioning and protection-cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia. 2015;70:467–482. doi: 10.1111/anae.12975. - DOI - PMC - PubMed
    1. Kojima A, Kitagawa H, Omatsu-Kanbe M, Matsuura H, Nosaka S. Sevoflurane protects ventricular myocytes against oxidative stress-induced cellular Ca2+ overload and hypercontracture. Anesthesiology. 2013;119:606–620. doi: 10.1097/ALN.0b013e318292ee52. - DOI - PubMed

Publication types

MeSH terms