- 作者：Alberto Zangrillo MD?/sup> ; Valentina Testa MD?/sup> ; Valeria Aldrovandi MD?/sup> ; Antonio Tuoro MD&dagger ; ; Giuseppina Casiraghi MD?/sup> ; Francesca Cavenago MD?/sup> ; Melissa Messina MD?/sup> ; Elena Bignami MD?/sup> ; Giovanni Landoni MD?/sup> ; ; landoni.giovanni@hsr.it
- 关键词：halogenated anesthetics ; volatile anesthetics ; total intravenous anesthesia ; noncardiac surgery ; thoracic surgery ; vascular surgery ; cardiac troponin I ; myocardial damage ; anesthesia
- 刊名：Journal of Cardiothoracic and Vascular Anesthesia
- 出版年：2011
- 出版时间：December 2011
- 年：2011
- 卷：25
- 期：6
- 页码：902-907
- 全文大小：415 K
Objective
Volatile anesthetics reduce the risk of myocardial infarction and mortality in coronary artery surgery. Recently, the American College of Cardiology/American Heart Association Guidelines suggested the use of volatile anesthetic agents for the maintenance of general anesthesia during noncardiac surgery in patients at risk for perioperative myocardial ischemia, but no randomized experience to document the cardioprotective effects of these agents exists in this setting. Therefore, the authors performed a prospective, randomized, controlled trial to compare the effects of sevoflurane versus total intravenous anesthesia, in terms of postoperative cardiac troponin I release in patients undergoing noncardiac surgery.Design
A randomized, controlled trial.
Setting
A teaching hospital.
Participants
Eighty-eight consecutive patients undergoing noncardiac surgery.
Interventions
Patients were allocated randomly to receive either volatile anesthetic (44 patients) as the main anesthetic agent or total intravenous anesthesia (TIVA) (44 patients).
Measurements
Postoperative cardiac troponin I release was measured as a marker of myocardial necrosis. Patients with detectable postoperative troponin I in the sevoflurane group (12/44, 27.3 % ) were similar to those in the propofol group (9/44, 20.5 % ; p = 0.6). There was no significant reduction of postoperative median peak cTnI release (0.16 ¡À 0.71 ng/mL in the sevoflurane group compared with the TIVA group, 0.03 ¡À 0.08 ng/mL; p = 0.4). Three patients died at the 1-year follow-up for noncardiac causes (2 in the TIVA group).
Conclusions
In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery.