Email this article Is it possible to augment myocardial protection during cardiopulmonary bypass by administration of inhalational anesthetics?
- Authors: Molchan N.S.1, Polushin Y.S.1, Zhloba A.A.1, Kobak A.E.1, Khryapa A.A.1
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Affiliations:
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Issue: Vol 47, No 3 (2019)
- Pages: 221-227
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1079
- DOI: https://doi.org/10.18786/2072-0505-2019-47-036
- ID: 1079
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Abstract
Aim: To evaluate the possibility to augment myocardial protection with desflurane and sevoflurane by prolongation of their delivery into the oxygenator of the cardiopulmonary bypass (CPB) pump during surgical myocardial revascularization.
Materials and methods: This randomized prospective study included 75 patients with ischemic heart disease who underwent aortocoronary and mammary coronary bypass grafting with extracorporeal circulation from 2014 to 2017. The patients were allocated into the three study group by means of a random number table generated by Statistica 10.0 software, depending on the anesthetic agent used: group 1, desflurane (n=30), group 2, sevoflurane (n=28), and group 3 (control), propofol (n=17). Desflurane and sevoflurane were delivered into the oxygenator during the artificial circulation. Hemodynamic parameters were assessed, such as cardiac index, total peripheral vascular resistance index, pulmonary artery wedge pressure. Changes in lactate, pyruvate, alanine, glutamate, glutamine, aspartate, asparagine, taurine, leucine, isoleucine and valine levels over time were assessed in blood taken from the heart coronary sinus before aortal clamping, before release of the clamp and after 30 minutes of reperfusion. During the first 24 hours post perfusion, we assessed the incidence of postperfusion heart failure (PPHF), duration of mechanical ventilation and duration of stay in the intensive care unit. Troponin I levels were measured at 12 and 24 hours after the intervention.
Results: There were no significant differences in the changes of the hemodynamic parameters over time in all the groups. The PPHF incidence and the course of the postoperative period were similar in all the groups. Irrespective on the type of the anesthesia, lactate and pyruvate levels increased during the CPB, with no significant differences between the groups, as well as the postoperative troponin I levels at 12 and 24 hours after surgery. No differences between the groups were found for the changes of amino acid levels over time, except a significant reduction of alanine levels during the aortal clamp in the group 3.
Conclusion: Prolongation of desflurane and sevoflurane delivery into the CPB pump oxygenator does not augment myocardial protection during myocardial revascularization surgery.
About the authors
N. S. Molchan
Academician I.P. Pavlov First St. Petersburg State Medical University
Author for correspondence.
Email: johnwolver2@gmail.com
Nikolay S. Molchan - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation.
6-8 L'va Tolstogo ul., Saint Petersburg, 197022, Tel.: +7 (812) 338 60 77
Russian FederationYu. S. Polushin
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: polushin1@gmail.com
ORCID iD: 0000-0002-6313-5856
Yury S. Polushin -MD, PhD, Professor, Member of Russ. Acad. Sci., Head of Research Centre for Anesthesiology and Emergency Medicine, Head of the Chair of Anesthesiology and Resuscitation.
6-8 L'va Tolstogo ul., Saint Petersburg, 197022
Russian FederationA. A. Zhloba
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: zhloba@mail.spbnit.ru
ORCID iD: 0000-0003-0605-7617
Alexander A. Zhloba - MD, PhD, Professor, Head of the Biochemistry Department, Scientific and Research Centre.
6-8 L'va Tolstogo ul., Saint Petersburg, 197022
Russian FederationA. E. Kobak
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: kobak2006@yandex.ru
Andrey E. Kobak - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation.
6-8 L'va Tolstogo ul., Saint Petersburg, 197022
Russian FederationA. A. Khryapa
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: alex_khryapa@yahoo.com
Aleksandr A. Khryapa - MD, PhD, Assistant Professor, Chair of Anesthesiology and Resuscitation, Head of the Department of Anesthesiology, Research Centre for Anesthesiology and Emergency Medicine.
6-8 L'va Tolstogo ul., Saint Petersburg, 197022
Russian FederationReferences
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