Sevoflurane and Isoflurane—Pharmacokinetics, Hemodynamic Stability, and Cardioprotective Effects During Cardiopulmonary Bypass

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• 作者：David Freiermuth ; MD^* ; Berend Mets ; MD ; PhD^&dagger ; ; Daniel Bolliger ; MD^* ; Oliver Reuthebuch ; MD^&Dagger ; ; Thomas Doebele ; Dipl Ing^&Dagger ; ; Markus Scholz ; PhD^§ ; ; Michael Gregor ; RN^* ; Matthias Haschke ; MD^‖ ; Manfred Daniel Seeberger ; MD^* ; ^# ; Jens Fassl ; MD ; FASE^* ; ^{Jens.fassl@usb.ch}
• 关键词：volatile anesthetics ; isoflurane ; sevoflurane ; minimized extracorporeal cardiopulmonary bypass ; pharmacokinetics ; hemodynamic effects ; cardioprotective effects
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：30
• 期：6
• 页码：1494-1501
• 全文大小：268 K
• 卷排序：30

文摘

This study aimed to evaluate the pharmacokinetic profiles of sevoflurane and isoflurane during use of minimized extracorporeal circulation to perform coronary artery bypass graft surgery. Furthermore, cardiovascular stability during bypass and the postoperative release of troponins were evaluated.DesignProspective, randomized study.SettingUniversity hospital.ParticipantsThe study comprised 31 adult patients undergoing coronary artery bypass grafting.InterventionsThe pharmacokinetic measurements of the concentration of the volatile anesthetics in the arterial and venous blood, air inlet, air outlet, and gas exhaust of the extracorporeal circulation were recorded. Secondary end-points were cardiovascular stability during bypass, amount of postoperative release of troponin, time to extubation, time to discharge from the intensive care unit and the hospital, and 30-day mortality.Measurements and Main ResultsThirty patients completed the protocol. The pharmacokinetics of isoflurane and sevoflurane were almost identical, with a rapid wash-in (time to reach 50% of arterial steady state) concentration of 0.87±0.97 minutes and 1.14±0.35 minutes for isoflurane and sevoflurane, respectively, and a biphasic venous elimination with a terminal half-life of approximately 10 minutes for both compounds. There was a correlation between the gas inlet and the gas exhaust of the extracorporeal circulation. No difference in cardiovascular stability was found. High-sensitivity troponin concentrations on the first postoperative morning were 0.355±0.312 µg/mL and 0.225±0.111 µg/mL in the isoflurane and sevoflurane groups, respectively (p = 0.147).ConclusionsThe study found similar pharmacokinetics regarding wash-in and wash-out for sevoflurane and isoflurane. In addition, no difference in cardiovascular stability was found. The markers of cardiac damage were not different between the two anesthetics. Based on these data, sevoflurane and isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation.