Key result
Anaesthesia and ICU sedation with sevoflurane did not significantly reduce myocardial injury assessed by cardiac troponin I compared to propofol in patients undergoing cardiac surgery (mean difference 0.44 mg/ml, p=0.69).
Why the study?
The study was conducted to evaluate whether anaesthesia and ICU sedation with sevoflurane protects against ischemia-reperfusion injury in cardiac surgery.
Does anaesthesia and ICU sedation with sevoflurane reduce myocardial injury in patients undergoing cardiac surgery with cardiopulmonary bypass?
RCT (n=81)
Open-label
1:1 ratio, stratified by age, sex, and Euroscore II
No
Does anaesthesia and ICU sedation with sevoflurane reduce myocardial injury in patients undergoing cardiac surgery with cardiopulmonary bypass?
Mean Difference: 0.44
p-value: p=0.69
Anaesthesia and ICU sedation with sevoflurane does not reduce myocardial injury compared to propofol in patients undergoing cardiac surgery, and may increase the risk of acute renal failure.
Sevoflurane offers no myocardial protection over propofol in cardiac surgery; confirms absence of benefit and supports propofol preference.
BACKGROUND: To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release. METHODS: We performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU. RESULTS: Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ± 1.09 μg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay. CONCLUSION: The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.
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Guinot et al. (2020) conducted an RCT in Cardiac surgery with cardiopulmonary bypass (n=81). Sevoflurane vs. Propofol was evaluated on Postoperative kinetics of cardiac troponin I (cTnI) in the 48 hours after surgery (MD 0.44 mg/ml, p=0.69). Anaesthesia and ICU sedation with sevoflurane did not significantly reduce myocardial injury assessed by cardiac troponin I compared to propofol in patients undergoing cardiac surgery (mean difference 0.44 mg/ml, p=0.69).
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