Match!

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 & Analgesia3.489
· DOI :10.1213/01.ane.0000230612.29452.a6
Zhengyuan Xia32
Estimated H-index: 32
,
Zhiyong Huang3
Estimated H-index: 3
,
David M. Ansley20
Estimated H-index: 20
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 (93)
📖 Papers frequently viewed together
10 Authors (Stefan De Hert, ..., I. E. Rodrigus)
327 Citations
288 Citations
209 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References30
Newest
#1Wendy Lim (McMaster University)H-Index: 36
#2Ismael Qushmaq (McMaster University)H-Index: 14
Last. Philip J. Devereaux (McMaster University)H-Index: 74
view all 6 authors...
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...
71 CitationsSource
#1Zhong-yuan Xia (WHU: Wuhan University)H-Index: 17
#2Xian-Yi Liu (WHU: Wuhan University)H-Index: 3
Last. Zhengyuan Xia (WHU: Wuhan University)H-Index: 32
view all 6 authors...
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...
23 CitationsSource
#1Tao LuoH-Index: 45
#2Zhengyuan XiaH-Index: 32
Last. Xian-Yi LiuH-Index: 3
view all 9 authors...
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 ...
49 CitationsSource
#1Kelvin H.H. Lim (BRI: Bristol Royal Infirmary)H-Index: 11
#2Andrew P. Halestrap (BRI: Bristol Royal Infirmary)H-Index: 88
Last. M.-Saadeh Suleiman (BRI: Bristol Royal Infirmary)H-Index: 4
view all 4 authors...
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...
57 CitationsSource
#1Matthias L. RiessH-Index: 24
#2Leo G. KevinH-Index: 14
Last. David F. StoweH-Index: 44
view all 6 authors...
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) ...
65 CitationsSource
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. ...
21 CitationsSource
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...
32 CitationsSource
#1Stefan De HertH-Index: 13
Last. I. E. RodrigusH-Index: 6
view all 8 authors...
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...
181 CitationsSource
#1Zhengyuan Xia (WHU: Wuhan University)H-Index: 32
#2Jiazhen Gu (WHU: Wuhan University)H-Index: 1
Last. Jinfu Yu (WHU: Wuhan University)H-Index: 1
view all 5 authors...
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...
52 CitationsSource
#1Peter ConzenH-Index: 40
#2Susanne C. FischerH-Index: 2
Last. Klaus PeterH-Index: 46
view all 4 authors...
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...
160 CitationsSource
Cited By93
Newest
#1Alice BonanniH-Index: 13
#2Alessio SignoriH-Index: 20
Last. Giacomo DeferrariH-Index: 40
view all 7 authors...
BACKGROUND: The aim of this systematic review and meta-analysis was to assess the effect of anesthesia maintenance with volatile agents compared with propofol on both short- and long-term mortality (primary outcomes) and major clinical events in adults undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Randomized clinical trials on the effects of current volatile anesthetics versus propofol in adults undergoing cardiac surgery with cardiopulmonary bypass were searched (1965 to Sept...
Source
Source
AbstractThe anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. Th...
Source
#1Binbin Wang (HUST: Huazhong University of Science and Technology)H-Index: 2
#2Qiong-Feng Wu (HUST: Huazhong University of Science and Technology)H-Index: 5
Last. Yi-Mei Du (HUST: Huazhong University of Science and Technology)H-Index: 11
view all 11 authors...
Ca2+ entry via the transient receptor potential vanilloid 4 (TRPV4) channel contributes to Ca2+ overload and triggers many pathophysiological conditions, including myocardial ischemia/reperfusion (I/R) injury. Propofol, a widely used intravenous anaesthetic, attenuates myocardial I/R injury. However, the mechanism of propofol remains to be examined. The present study aims to test the hypothesis that propofol attenuates myocardial I/R injury through the suppression of TRPV4. We used a murine ex v...
Source
#1Haocong JiH-Index: 1
#2Rongzong QiuH-Index: 1
Last. Dongdong Yuan (SYSU: Sun Yat-sen University)H-Index: 12
view all 7 authors...
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...
Source
Source
#1Haobo Li (Harvard University)H-Index: 18
#2Zhengyuan Xia (HKU: University of Hong Kong)H-Index: 32
Last. Hong Zheng (First Affiliated Hospital of Xinjiang Medical University)H-Index: 1
view all 5 authors...
2 CitationsSource
#1Qingping Wu (HUST: Huazhong University of Science and Technology)H-Index: 5
#2Tingting Wang (HUST: Huazhong University of Science and Technology)H-Index: 13
Last. Zhengyuan Xia (HKU: University of Hong Kong)H-Index: 32
view all 10 authors...
16 CitationsSource
#1Rosalba Romano (Imperial College London)H-Index: 4
#2Simona M. Cristescu (Radboud University Nijmegen)H-Index: 34
Last. Nandor Marczin (Imperial College London)H-Index: 13
view all 4 authors...
4 CitationsSource
#1Hongwei Zhao (TMUCIH: Tianjin Medical University Cancer Institute and Hospital)H-Index: 2
#2Xiaobei Zhang (TMUCIH: Tianjin Medical University Cancer Institute and Hospital)H-Index: 2
Last. Kaiyuan Wang (TMUCIH: Tianjin Medical University Cancer Institute and Hospital)H-Index: 2
view all 8 authors...
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...
5 CitationsSource