Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study
Détails
ID Serval
serval:BIB_B03A0ACA2AC2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study
Périodique
Anesthesiology
ISSN
0003-3022 (Print)
Statut éditorial
Publié
Date de publication
06/2003
Volume
98
Numéro
6
Pages
1315-27
Notes
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Jun
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Jun
Résumé
BACKGROUND: Preconditioning by volatile anesthetics is a promising therapeutic strategy to render myocardial tissue resistant to perioperative ischemia. It was hypothesized that sevoflurane preconditioning would decrease postoperative release of brain natriuretic peptide, a biochemical marker for myocardial dysfunction. In addition, several variables associated with the protective effects of preconditioning were evaluated. METHODS: Seventy-two patients scheduled for coronary artery bypass graft surgery under cardioplegic arrest were randomly assigned to preconditioning during the first 10 min of complete cardiopulmonary bypass with either placebo (oxygen-air mixture only) or sevoflurane 4 vol% (2 minimum alveolar concentration). No other volatile anesthetics were administered at any time during the study. Treatment was strictly blinded to anesthesiologists, perfusionists, and surgeons. Biochemical markers of myocardial dysfunction and injury (brain natriuretic peptide, creatine kinase-MB activity, and cardiac troponin T), and renal dysfunction (cystatin C) were determined. Results of Holter electrocardiography were recorded perioperatively. Translocation of protein kinase C was assessed by immunohistochemical analysis of atrial samples. RESULTS: Sevoflurane preconditioning significantly decreased postoperative release of brain natriuretic peptide, a sensitive biochemical marker of myocardial contractile dysfunction. Pronounced protein kinase C delta and epsilon translocation was observed in sevoflurane-preconditioned myocardium. In addition, postoperative plasma cystatin C concentrations increased significantly less in sevoflurane-preconditioned patients. No differences between groups were found for perioperative ST-segment changes, arrhythmias, or creatine kinase-MB and cardiac troponin T release. CONCLUSIONS: Sevoflurane preconditioning preserves myocardial and renal function as assessed by biochemical markers in patients undergoing coronary artery bypass graft surgery under cardioplegic arrest. This study demonstrated for the first time translocation of protein kinase C isoforms delta and epsilon in human myocardium in response to sevoflurane.
Mots-clé
Adult
Aged
Aged, 80 and over
Anesthesia, Inhalation
Anesthetics, Inhalation/*pharmacology
Biological Markers
*Coronary Artery Bypass
Creatine Kinase/blood
Cystatins/blood
Electrocardiography, Ambulatory
Female
Heart Diseases/diagnosis/*metabolism/*prevention & control
Humans
Immunohistochemistry
Ischemic Preconditioning, Myocardial/*methods
Kidney Diseases/diagnosis/*metabolism/*prevention & control
Male
Methyl Ethers/*pharmacology
Middle Aged
Myocardium/pathology
Prognosis
Protein Kinase C/blood
Treatment Outcome
Troponin T/blood
Pubmed
Web of science
Création de la notice
28/01/2008 11:43
Dernière modification de la notice
20/08/2019 16:19