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J Thorac Cardiovasc Surg 2009;137:1436-1442
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Impact of preconditioning protocol on anesthetic-induced cardioprotection in patients having coronary artery bypass surgery

^a Department of Anesthesiology, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
^b Department of Anesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany
^c Department of Thoracic and Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
^d Department of Anesthesiology, Slingeland Ziekenhuis, Doetinchem, The Netherlands
^e Department of Anesthesiology, South Tyneside District Hospital, South Shields, United Kingdom

Received for publication January 30, 2008; accepted for publication April 6, 2008.

^_* Address for reprints: Benedikt Preckel, MD, MA, DEAA, Academic Medical Center, University of Amsterdam, Postbus 22660 H1Z-120, 1100 DD Amsterdam, The Netherlands. (Email: b.preckel{at}amc.uva.nl).

Objective: Anesthetic preconditioning may contribute to the cardioprotective effects of sevoflurane in patients having coronary artery bypass surgery. We investigated whether 2 different sevoflurane administration protocols can induce preconditioning in patients having coronary artery bypass.

Methods: Thirty patients were randomly allocated to 1 of 3 groups. All patients received a total intravenous anesthesia with sufentanil (0.3 µg^–1 · kg· h^–1) and propofol as target controlled infusion (2.5 µg/mL). The control group had no further intervention; 10 minutes prior to establishing the extracorporeal circulation, patients of the sevoflurane-I group received 1 minimum alveolar concentration of sevoflurane for 5 minutes. Patients of the sevoflurane-II group received (2 times) 5 minutes of sevoflurane, interspersed by 5-minute washout 10 minutes prior to extracorporeal circulation. Troponin I was measured as marker of cardiac cellular damage.

Results: Peak levels of troponin I release were observed at 4 hours after cardiopulmonary bypass and were not affected by 1 cycle of sevoflurane administration (controls: 14 ± 3 ng/mL vs sevoflurane-I group, 14 ± 3 ng/mL). Two periods of sevoflurane preconditioning significantly reduced cellular damage compared with controls (peak troponin I level sevoflurane-II group, 7 ± 2 ng/mL).

Conclusion: These data show that sevoflurane-induced preconditioning is reproducible in patients having coronary artery bypass but depends on the preconditioning protocol used.

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				J. Frassdorf, S. De Hert, and W. Schlack Anaesthesia and myocardial ischaemia/reperfusion injury Br. J. Anaesth., July 1, 2009; 103(1): 89 - 98. [Abstract] [Full Text] [PDF]