A comparison of total intravenous anesthesia, sevoflurane, and isoflurane anesthesia for preconditioning in cardiac surgery

Background: In this study we compared the myocardial protective effects of fentanyl-based total intravenous anesthesia (TIVA), sevoflurane and isoflurane. Methods: After ethic committee approval, 57 patients who were scheduled to undergo open heart surgery using cardiopulmonary bypass (CPB) were randomized into three groups. Following standard induction, group 1 (TIVA group; n=17) received fentanyl-midazolam-pancuronium, group 2 (Sevo group; n=20) received 1 MAC sevoflurane and group 3 (Iso group; n=20) received 1 MAC isoflurane for maintenance. During preoperative period and on postoperative third day, left ventricle functions and cardiac scores were evaluated by transthoracic echocardiography. Cardiac troponin I (cTnI) and creatine kinase MB fraction (CKMB) were measured before CPB and at sixth hour, day one, two and three following CPB. For lactate measurement, blood samples were collected from arterial line and retrograde cannula before and after CPB and following declamping. Results: Demographic parameters were similar among three groups. Cardiac index and output increased in all three groups after CPB. Creatine kinase MB fraction and cTnI levels were similar among groups before CPB, those levels increased in all groups at sixth hour after CPB. Although there was not a statistically significant difference among the groups, this increase was the highest in TIVA group. After declamping, the lactate levels collected from retrograde cannula increased in all groups. Conclusion: As a result, as all the groups have preconditioning potential, although we did not find a significant difference between fentanyl-based TIVA group and volatile anesthetics in terms of myocardial protection, we could say that volatile anesthetics are more cardioprotective, compared to fentanyl-based TIVA group.