Résumé
Background: Volatile anesthetics provide myocardial protection during cardiac surgery. Sevoflurane and desflurane are both efficient agents that allow immediate extubation after off-pump coronary artery bypass grafting (OPCABG). This study compared the incidence of arrhythmias after OPCABG with the two agents. Materials and Methods: Forty patients undergoing OPCABG with immediate extubation and perioperative high thoracic analgesia were included in this controlled, double-blind study; anesthesia was either provided using 1 MAC of sevoflurane (SEVO-group) or desflurane (DES-group). Monitoring of perioperative arrhythmias was provided by continuous monitoring of the EKG up to 72 hours after surgery, and routine EKG monitoring once every day, until time of discharge. Patient data, perioperative arrhythmias, and myocardial protection (troponin I, CK, CK-MB-ratio, and transesophageal echocardiography examinations) were compared using t-test, Fisher's exact test or two-way analysis of variance for repeated measurements; P < 0.05. Results: Patient data and surgery-related data were similar between the two groups; all the patients were successfully extubated immediately after surgery, with similar emergence times. Supraventricular tachycardia occurred only in the DES-group (5 of 20 patients), atrial fibrillation was significantly more frequent in the DES group versus SEVO-group, at five out of 20 versus one out of 20 patients, respectively. Myocardial protection was equally achieved in both groups. Discussion: Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery.
Sujets)
Sujet âgé , Anesthésie par inhalation/méthodes , Anesthésiques par inhalation/effets indésirables , Troubles du rythme cardiaque/induit chimiquement , Pontage coronarien à coeur battant , MB Creatine kinase/sang , Méthode en double aveugle , Femelle , Humains , Incidence , Isoflurane/effets indésirables , Isoflurane/analogues et dérivés , Mâle , Éthers méthyliques/effets indésirables , Adulte d'âge moyen , Débit expiratoire de pointe/effets des médicaments et des substances chimiques , Projets pilotes , Tachycardie supraventriculaire/induit chimiquement , Tachycardie supraventriculaire/prévention et contrôle , Résultat thérapeutique , Troponine I/sangRésumé
Para evaluar la efectividad del sulfato de magnesio intravenoso en la profilaxis de arritmias supraventriculares en el posoperatorio de cirugía cardiovascular con circulación extracorpórea, se condujo este diseño prospectivo, randomizado y controlado. El atenolol 50 mg por día en forma precoz fue significativamente más efectivo que el sulfato de magnesio intravenoso en dosis altas. El antecedente de taquiarritmias supraventriculares, no estar tratado con atenolol, el grupo de pacientes coronarios, el mayor tiempo de clampeo y la mayor edad codificada por décadas, predijeron en forma independiente la aparición de estas arritmias en el posoperatorio