Comparison of the myocardial protective effect of sevoflurane and isoflurane in high-risk cardiac patients undergoing coronary artery bypass grafting surgery: a randomized study

Objective The aim of this study was to assess the effect of sevoflurane and isoflurane in high-risk cardiac patients undergoing coronary artery bypass grafting surgery.Patients and methods This study included 228 patients undergoing coronary artery bypass grafting surgery. This was a randomized study. This study was carried out at cardiac centers. The patients in this study were divided into two groups. In the sevoflurane group, the patients received sevoflurane (end-tidal concentration of 1–4%) as an inhalational agent during the entire procedure (before, during, and after cardiopulmonary bypass). In the isoflurane group, the patients received isoflurane (end-tidal concentration of 0.5–2%) as an inhalational agent during the entire procedure (before, during, and after cardiopulmonary bypass). The monitors measured the heart rate, mean arterial blood pressure, a continuous ECG with an automatic ST-segment analysis (leads II and V), central venous pressure, mean arterial pulmonary pressure, pulmonary capillary wedge pressure, pulmonary and systemic vascular resistances, cardiac index, urine output, troponin I level, creatine kinase-MB level, required pharmacological, and mechanical support.Results The administration of sevoflurane decreased the heart rate, mean arterial blood pressure, cardiac index, mean arterial pulmonary pressure, and pulmonary and systemic vascular resistances compared with the administration of isoflurane (P<0.05). Also, it decreased the incidence of myocardial infarction, reflected in the troponin I level, creatine kinase-MB, ECG changes, and the development of new regional wall motion abnormalities (P<0.05). Sevoflurane decreased the requirement for pharmacological and mechanical support compared with isoflurane (P<0.05).Conclusion Sevoflurane is more cardioprotective than isoflurane. It decreases the incidence of myocardial infarction and the requirement for pharmacological and mechanical support, and duration of stay in the ICU and hospital.