What question did this study set out to answer?

To determine whether isoflurane anesthesia induces coronary artery steal and myocardial ischemia compared with sufentanil when hemodynamics are strictly controlled in high-risk patients undergoing elective CABG.

May 1, 1991AnesthesiologyOpen Access

Isoflurane Anesthesia and Myocardial Ischemia

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Why the study?

Does isoflurane anesthesia increase the risk of myocardial ischemia compared to sufentanil in high-risk patients undergoing elective CABG when hemodynamics are controlled?

Population

186 high-risk patients undergoing elective coronary artery bypass graft (CABG) surgery

Comparison

Isoflurane anesthesia under strict control of… vs Sufentanil anesthesia under strict control of…

Design

Cohort

Follow-up

Prebypass period for ischemia; unspecified for adverse…

Authors

JLJacqueline M. LeungUniversity of California, San Francisco PGP. GoehnerUniversity of California, San Francisco BOBrian O’KellyBeaumont Hospital

Discussion

Member takes

Implication

Isoflurane appears comparable to sufentanil for ischemia risk under hemodynamic control in CABG; cohort data leave open confirmation in randomized trials.

Key Points

To determine whether isoflurane anesthesia induces coronary artery steal and myocardial ischemia compared with sufentanil when hemodynamics are strictly controlled in high-risk patients undergoing elective CABG.
Evaluated 186 high-risk patients undergoing elective coronary artery bypass graft (CABG) surgery administered either isoflurane or sufentanil anesthesia.
Maintained strict hemodynamic control during the prebypass period, limiting heart rate and blood pressure deviations.
Monitored myocardial ischemia continuously using transesophageal echocardiography (TEE, n=162 interpretable) and Holter electrocardiography (ECG, n=181 interpretable).
Moderate-to-severe TEE ischemic episodes occurred in 21% of isoflurane patients (12/56) versus 20% of sufentanil patients (21/106) (P = 0.97), with no relation to isoflurane concentration (0.47–1.75%).
Electrocardiographic ischemia developed in 20% of isoflurane patients (12/59) compared with 18% of sufentanil patients (22/122) (P = 0.87), with no differences in duration or severity.
Adverse cardiac outcomes developed in 6% of isoflurane patients (4/62) compared to 12% of sufentanil patients (15/124) (P = 0.34).

Structured PICO

Does isoflurane anesthesia increase the risk of myocardial ischemia compared to sufentanil in high-risk patients undergoing elective CABG when hemodynamics are controlled?

Population

186 high-risk patients undergoing elective coronary artery bypass graft (CABG) surgery

Intervention

Isoflurane anesthesia under strict control of hemodynamics

Comparator

Sufentanil anesthesia under strict control of hemodynamics

Outcome

Incidence of myocardial ischemia during the prebypass period, measured by transesophageal echocardiography (TEE) and continuous Holter electrocardiography (ECG)surrogate

When hemodynamics are strictly controlled, isoflurane and sufentanil anesthesia are associated with similar rates of myocardial ischemia during elective CABG surgery.

Cite This Study

Leung et al. (1991) studied this question.

synapsesocial.com/papers/6a836452954bb9d4ab71d4d9 https://doi.org/10.1097/00000542-199105000-00007

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Implication

Isoflurane appears comparable to sufentanil for ischemia risk under hemodynamic control in CABG; cohort data leave open confirmation in randomized trials.

Isoflurane Anesthesia and Myocardial Ischemia

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Isoflurane Anesthesia and Myocardial Ischemia

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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