Does desflurane reduce postoperative maximum concentrations of cardiac biomarkers compared to sevoflurane in older adults undergoing low- to moderate-risk noncardiac surgery?
Desflurane does not exert clinically meaningful cardioprotective effects compared to sevoflurane in older adults undergoing low- to moderate-risk noncardiac surgery, as measured by postoperative cardiac biomarkers.
Background/Objectives: Previous preclinical studies have shown that desflurane might have the most significant cardioprotective effect of all volatile anesthetics. However, data regarding the cardioprotective effects of desflurane versus sevoflurane are lacking. Therefore, we evaluated the effect of the maintenance of anesthesia using desflurane versus sevoflurane on the postoperative maximum concentrations of cardiac biomarkers in older adults undergoing low- to moderate-risk noncardiac surgery. Methods: In this secondary analysis of a prospective randomized trial, we included all 190 older adults undergoing low- to moderate-risk noncardiac surgery. Patients were randomized to receive desflurane or sevoflurane for the maintenance of anesthesia. We administered desflurane or sevoflurane, aiming at a BIS value of 50 ± 5. The cardiac-specific biomarkers included troponin T, NT-proBNP, and copeptin, which were measured preoperatively, within one hour after surgery, and on the second postoperative day. Results: There were no significant differences between the desflurane and sevoflurane groups in the postoperative maximum concentrations of troponin T (11 ng.L−1 8; 16 versus 13 ng.L−1 9; 18; p = 0.595), NT-proBNP (196 pg.mL−1 90; 686 versus 253 pg.mL−1 134; 499; p = 0.288), or copeptin (19 pmol.L−1 7; 58 versus 12 pmol.L−1 6; 41; p = 0.096). We also observed no significant differences in the troponin T, NT-proBNP, or copeptin concentrations between the desflurane and sevoflurane groups at any measured timepoint (all p > 0.05). Conclusions: In contrast to preclinical studies, we did not observe a significant difference in the postoperative maximum concentrations of cardiac biomarkers. It seems likely that desflurane does not exert significant clinical meaningful cardioprotective effects in older adults. Thus, our results do not support the use of desflurane in patients undergoing low- to moderate-risk noncardiac surgery.
Taschner et al. (Sun,) studied this question.