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Large-dose Propofol During Cardiopulmonary Bypass Decreases Biochemical Markers of Myocardial Injury in Coronary Surgery Patients: A Comparison with Isoflurane

Published on Sep 1, 2006in Anesthesia & Analgesia3.49
· DOI :10.1213/01.ane.0000230612.29452.a6
Zhengyuan Xia32
Estimated H-index: 32
,
Zhiyong Huang3
Estimated H-index: 3
,
David M. Ansley19
Estimated H-index: 19
Cite
Abstract
We investigated if increasing propofol's dosage to augment its antioxidant capacity during cardiopulmonary bypass (CPB) could confer cardiac protection. Fifty-four coronary artery bypass graft surgery patients were randomly assigned to small-dose propofol (Group P; n = 18), large-dose propofol (Group HiP; n = 18), or isoflurane Group (Group I; n = 18). After the induction, anesthesia was maintained with an inspired concentration of isoflurane 1%-3.5% (Group I) or a continuous infusion of propofol 60 μg · kg -1 · min -1 (Group P) throughout the surgery. In Group HiP, this dose of propofol was increased to 120 μg · kg -1 · min -1 for 10 min before the onset of CPB until 15 min after aortic unclamping and then decreased to 60 μg · kg -1 · min -1 until the end of surgery. The duration of aortic cross-clamping was 83 ± 24, 88 ± 22, and 81 ± 20 min in Group P, Group HiP, and Group I, respectively (P >0.1). Plasma malondialdehyde, a marker of oxidative stress, was significantly lower at 8 h after CPB, and Troponin I was lower at 24 h after CPB in Group HiP compared with Group P and Group I (P < 0.05). There was a significant reduction in inotropic requirements for separation from CPB in Group HiP compared with Group I. Postoperative systemic vascular resistance was significantly reduced in Group HiP as compared with Group I. Mean cardiac index was significantly higher at 24 h after CPB in Group HiP compared with Group P and Group I (P < 0.05) (Group I, 2.2 ± 0.1; Group P, 2.3 ± 0.2; and Group HiP, 2.8 ± 0.3 L · min -1 · m -2 , respectively). The duration of intensive care unit stay was significantly shorter in Group Hi-P compared with Group I. We conclude that administration of a large dose of propofol during CPB attenuates postoperative myocardial cellular damage as compared with isoflurane or small-dose propofol anesthesia.
  • References (30)
  • Citations (88)
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References30
Newest
Published on Sep 28, 2005in Critical Care6.96
Wendy Lim36
Estimated H-index: 36
(McMaster University),
Ismael Qushmaq13
Estimated H-index: 13
(McMaster University)
+ 3 AuthorsP. J. Devereaux10
Estimated H-index: 10
(McMaster University)
Introduction Elevated troponin levels indicate myocardial injury but may occur in critically ill patients without evidence of myocardial ischemia. An elevated troponin alone cannot establish a diagnosis of myocardial infarction (MI), yet the optimal methods for diagnosing MI in the intensive care unit (ICU) are not established. The study objective was to estimate the frequency of MI using troponin T measurements, 12-lead electrocardiograms (ECGs) and echocardiography, and to examine the associat...
Zhong-yuan Xia15
Estimated H-index: 15
(WHU: Wuhan University),
Xian-Yi Liu3
Estimated H-index: 3
(WHU: Wuhan University)
+ 3 AuthorsZhengyuan Xia32
Estimated H-index: 32
(WHU: Wuhan University)
Objective This study was undertaken to demonstrate that gastrointestinal mucosal injury occurs during cardiopulmonary bypass in children, increasing systemic inflammatory responses, and to determine whether shen-fu injection (the major components of which are ginsenosides compound, extract of Panax ginseng shown to have antioxidant properties) could attenuate gastrointestinal mucosal injury and subsequent inflammatory responses. Methods Twenty-four children undergoing heart surgery for congenita...
Published on Jun 1, 2005in Anesthesia & Analgesia3.49
Tao Luo3
Estimated H-index: 3
,
Zhengyuan Xia32
Estimated H-index: 32
+ 6 AuthorsXian-Yi Liu3
Estimated H-index: 3
We investigated whether propofol can inhibit tumor necrosis factor (TNF)-α-induced apoptosis in cultured human umbilical vein endothelial cells (HUVECs). Isolated HUVECs were cultured in Dulbecco's modified Eagle medium supplemented with 20% bovine calf serum. HUVECs in untreated and propofol control groups were cultured at 37°C for 24.5 h. HUVECs in the TNF treatment groups were initially cultured for 30 min in the presence of TNF or various concentrations of propofol, respectively, which were ...
Published on Jun 1, 2005in Experimental Biology and Medicine3.00
Kelvin H.H. Lim11
Estimated H-index: 11
(BRI: Bristol Royal Infirmary),
Andrew P. Halestrap88
Estimated H-index: 88
+ 1 AuthorsM.Saadeh Suleiman17
Estimated H-index: 17
The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment (n = 8) and control (n =12) groups, were surgically prepared for cardio...
Published on Jan 1, 2005in Anesthesia & Analgesia3.49
Matthias L. Riess24
Estimated H-index: 24
,
Leo G. Kevin14
Estimated H-index: 14
+ 3 AuthorsDavid F. Stowe44
Estimated H-index: 44
Cardioprotection by anesthetic preconditioning (APC) can be abolished by nitric oxide (NO ) synthase inhibitors or by reactive oxygen species (ROS) scavengers. We previously reported attenuated mitochondrial electron transport (ET) and increased ROS generation during preconditioning sevoflurane exposure as part of the triggering mechanism of APC. We hypothesized that NO and other ROS mediate anesthetic-induced ET attenuation. Cardiac function and reduced nicotinamide adenine dinucleotide (NADH) ...
Published on Oct 1, 2004in Canadian Journal of Physiology and Pharmacology2.04
Zhengyuan Xia32
Estimated H-index: 32
,
David V. Godin30
Estimated H-index: 30
,
David M. Ansley19
Estimated H-index: 19
Previous studies have shown that reactive oxygen species mediated lipid peroxidation in patients undergoing cardiac surgery occurs primarily during cardiopulmonary bypass. We examined whether application of a high concen- tration of propofol during ischemia could effectively enhance postischemic myocardial functional recovery in the set- ting of global ischemia and reperfusion in an isolated heart preparation. Hearts were subjected to 40 min of global ischemia followed by 90 min of reperfusion. ...
Published on Sep 1, 2004in European Journal of Anaesthesiology4.14
Jean-Luc Fellahi16
Estimated H-index: 16
,
Xavier Gué4
Estimated H-index: 4
+ 2 AuthorsJean-Louis Gérard16
Estimated H-index: 16
Background and objective: Isoflurane has been shown experimentally to protect the myocardium against infarction but the clinical relevance of these findings is not yet well established. We therefore evaluated the effects of isoflurane administration before cardiopulmonary bypass (CPB) on postoperative cardiac troponin I (cTnI) release and clinical outcome in a large group of adult patients scheduled for cardiac surgery. Methods: Three hundred and fifty-nine consecutive patients were included pro...
Published on Jul 1, 2004in Anesthesiology6.42
Stefan G. De Hert28
Estimated H-index: 28
,
Philippe Van der Linden37
Estimated H-index: 37
+ 5 AuthorsInez I.E. Rodrigus6
Estimated H-index: 6
Background: Volatile anesthetics protect the myocardium during coronary surgery. This study hypothesized that the use of a volatile agent in the anesthetic regimen would be associated with a shorter intensive care unit (ICU) and hospital length of stay (LOS), compared with a total intravenous anesthetic regimen. Methods: Elective coronary surgery patients were randomly assigned to receive propofol (n = 80), midazolam (n = 80), sevoflurane (n = 80), or desflurane (n = 80) as part of a remifentani...
Zhengyuan Xia32
Estimated H-index: 32
(WHU: Wuhan University),
Jiazhen Gu1
Estimated H-index: 1
(WHU: Wuhan University)
+ 2 AuthorsJinfu Yu1
Estimated H-index: 1
(WHU: Wuhan University)
Abstract Objective The endothelium-derived vasoconstrictor endothelin-1 is increased after cardiopulmonary bypass in children with congenital heart defects. This study determines whether antioxidant therapy with Salvia miltiorrhiza injection, an herb extract containing phenolic compounds, prevents the postoperative increase of endothelin-1. The relationship between endothelin-1 and the endothelium-derived prostacyclin (prostaglandin I2) and thromboxane A2 postoperatively is also investigated. Me...
Published on Oct 1, 2003in Anesthesiology6.42
P. Conzen39
Estimated H-index: 39
,
Susanne Fischer2
Estimated H-index: 2
+ 1 AuthorsK. Peter45
Estimated H-index: 45
Background: Sevoflurane, like other halogenated anesthetics, has been shown to have a protective effect on the myocardium at risk after an ischemic injury. The current study tested the hypothesis that such beneficial effects, so far mainly seen in the laboratory, are reproducible in humans. Methods: After institutional review board approval, 20 patients scheduled to undergo elective off-pump coronary artery bypass surgery were randomized to receive general anesthesia with either sevoflurane or p...
Cited By88
Newest
Published on Sep 1, 2019in Life Sciences3.45
Haocong Ji1
Estimated H-index: 1
,
Rongzong Qiu1
Estimated H-index: 1
+ 4 AuthorsDongdong Yuan8
Estimated H-index: 8
(SYSU: Sun Yat-sen University)
Abstract Aims Monocyte-endothelial adhesion is considered to be the primary initiator of inflammatory vascular diseases, such as atherosclerosis. Connexin 43 (Cx43) has been reported to play an important part in this process, however, the underlying mechanisms are not fully understood. Intravenous anesthetics, propofol is commonly used in the perioperative period and in the intensive care unit, and considered to have good anti-inflammatory and antioxidant effects. Thus, we speculate that propofo...
Published on Jun 24, 2018in Oxidative Medicine and Cellular Longevity4.87
Haobo Li1
Estimated H-index: 1
(Harvard University),
Zhengyuan Xia32
Estimated H-index: 32
(HKU: University of Hong Kong)
+ 2 AuthorsHong Zheng1
Estimated H-index: 1
(First Affiliated Hospital of Xinjiang Medical University)
Published on Mar 21, 2018in European Heart Journal23.24
Qingping Wu8
Estimated H-index: 8
(HUST: Huazhong University of Science and Technology),
Tingting Wang12
Estimated H-index: 12
(HUST: Huazhong University of Science and Technology)
+ 7 AuthorsZhengyuan Xia32
Estimated H-index: 32
(HKU: University of Hong Kong)
Published on Jan 1, 2018in Oxidative Medicine and Cellular Longevity4.87
Hongwei Zhao1
Estimated H-index: 1
(TMUCIH: Tianjin Medical University Cancer Institute and Hospital),
Xiaobei Zhang1
Estimated H-index: 1
(TMUCIH: Tianjin Medical University Cancer Institute and Hospital)
+ 5 AuthorsKaiyuan Wang1
Estimated H-index: 1
(TMUCIH: Tianjin Medical University Cancer Institute and Hospital)
We aimed to evaluate the cardioprotective effect and mechanism of propofol in anthracycline-induced cardiomyocyte apoptosis. We selected the rat myocardial cell line, H9c2, and primary cardiomyocytes for in vitro study. The cardiomyocytes were treated with vehicle, Adriamycin® (ADM), propofol, or a combination of ADM and propofol. The proportion of apoptotic cells and the expression of miR-181a were detected by flow cytometry and real-time PCR, respectively. Luciferase assays were performed to e...
Published on Nov 1, 2017in Journal of the American College of Cardiology18.64
Olli Arola4
Estimated H-index: 4
(TYKS: Turku University Hospital),
Antti Saraste35
Estimated H-index: 35
(TYKS: Turku University Hospital)
+ 26 AuthorsRisto O. Roine41
Estimated H-index: 41
(TYKS: Turku University Hospital)
The authors previously reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA).A pre-defined secondary objective was to assess the effect of inhaled xenon on myocardial ischemic damage in the same study population.A total of 110 comatose patients who had experienced OHCA from a cardiac cause were randomized to receive either inhaled xenon (40% end-tidal concentration) combined with hypothermia (33°C...
Published on Aug 1, 2017in Journal of Clinical Anesthesia3.54
Dib El R. P17
Estimated H-index: 17
(McMaster University),
J. G. Pereira21
Estimated H-index: 21
(UNESP: Sao Paulo State University)
+ 7 AuthorsPreethy J Mathew8
Estimated H-index: 8
(PGIMER: Post Graduate Institute of Medical Education and Research)
Abstract Study objective To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting. Design A systematic review. Setting A hospital-affiliated university. Measurements The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10), MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the GRADE approach to rate overall certainty of the evidence. Resul...
L.M. Torres (UCA: University of Cádiz), A. Martínez Ruiz2
Estimated H-index: 2
(UCA: University of Cádiz)
L.M. Torres (UCA: University of Cádiz), A. Martínez Ruiz2
Estimated H-index: 2
(UPV/EHU: University of the Basque Country)
Published on Jul 1, 2017in Heart5.08
Ronghua Zhou8
Estimated H-index: 8
(Sichuan University),
Hui Yu1
Estimated H-index: 1
(Sichuan University)
+ 9 AuthorsMing Luo3
Estimated H-index: 3
(Sichuan University)
Objective This study was conducted to determine whether the administration of intralipid just before aortic cross-unclamping would reduce myocardial injury in patients undergoing valve replacement surgery. Methods Seventy-three adult patients, scheduled for elective aortic or mitral valve surgery without significant coronary stenosis (>70%), were randomly assigned to the intralipid postconditioning (ILPC) group (n=37) or control group (n=36): the ILPC group received an intravenous infusion of 20...
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