ABSTRACT
Despite advances in anaesthesia and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. In this study, we evaluated the effect of two anaesthetic techniques, sevoflurane/fentanyl versus propofol/fentanyl on neurological outcome and S100S Protein levels and its correlation to secretion of cytokine IL-6 in patients undergoing coronary artery bypass grafting surgery [CABG]. Thirty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective study. Sevoflurane was used in group S and propofol in group P. Neurological examination was performed preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S100B Protein and IL-6 were collected before anaesthesia [TO], after heparinization and before CPB [Tl], after aortic declamping [T2], end of CPB [T3] and 24 hours after the operation [T4] in all patients. S-100B, Protein levels increased with the beginning of surgery in both groups but did not reach a pathological level except after aortic declamping [T2]. Maximum levels were reached at the end of operation [T3] and decreased to baseline levels at 24 hr postoperatively [T4]. The increase was statistically significant in both groups [at T2 and T3] but no significant difference was observed between the two groups. IL-6 level was significantly higher in Group S than in Group P before the start of cardiopulmonary bypass [Tl]. After aortic declamping [T2], concentration of IL-6 started to increase significantly and peaked at the end of operation [T3] but there were no differences between groups after cardiopulmonary bypass or postoperatively. There was a positive correlation between IL-6 and S-100B in both groups. Despite the increase in S-100B protein levels, no difference in deterioration of neurological examination after the operation was seen between groups. We conclude that propofol appears to offer no advantage over Sevoflurane for brain protection during CPB in this preliminary study. Also we concluded that the choice of anaesthetic technique may affect the pro-inflammatory cytokine response to surgery. However, neither technique could modify the cytokine response to the effect of the ischemia- reperfusion phenomenon or CPB itself