RESUMO
The brief period of ischemia appear to precondition the myocardium against the reversible and irreversible tissue injury, including stunning, infarction and development of malignant arrhythmias. On the other hand, exposures of myocardium to volatile anesthetics induce similar cardioprotective effect against ischemia activating the same mediators and receptors of ischemic preconditioning [ICP], enhance and augment ICR Anesthetic preconditioning [APC] is a well documented phenomenon with effective cardioprotection against ischemia in experimental studies applied on different animal species, also on isolated human myocardium independent of improvement in oxygen demand -supply ratio. Recurrently, APC was reported with few clinical studies using different parameters to evaluate the preconditioning or the cardioprotective effect. The aim of the work is to evaluate the cardioprotective effect [APC] of sevoflurane against ischemia induced by aortic crossclamping in comparison to propofol in coronary artery bypass graft surgeries. This study was conducted on 38 patients admitted to National Heart Institute undergoing elective coronary artery bypass graft surgeries [CABG]. Patients were randomly equally allocated to one of two groups [19/ group]: Sevoflurane G [G1] and Propofol G [G2]. There was no statistical significant difference between both groups regarding demographic data [age, sex height, BSA], preoperative medications, diseases or echo findings, time of CPB time and aortic crossclamping or number of coronary grafts. There was no statistical significant difference between both groups regarding: HR. MPA, SVRI or CVP. There was no statistical significant difference between both groups regarding ventricular fibrillation or ECG ischemic changes. Post bypass-CI in G1 [2.6 +/- 0.3 L/min/ m[2]] was statistically significantly higher in G2 [2.1 +/- 0.1 L/min /m[2]]. There was high statistical significant difference between both groups, P-Value= [0.0009] < [0.001]. Average of adrenaline support in G1 was [75 +/- 25 ng/kg/min] and in G2 was [150 +/- 50 ng/kg/min] with high statistical significant difference between both groups, P-Value= [0.0001] < [0.001]. Number of patients who received adrenaline in G1 was equal 8 [42%] while in G2 was 13 [68%] with statistical significant difference between both groups, P-Value = [0.0128] < [0.5]. Exposure of the myocardium to sevoflurane [anesthetic preconditioning] before aortic cross clamping induce significant reduction in myocardial damage and dysfunction in comparison to the propofol during coronary artery bypass graft surgeries using the cardiopulmonary bypass. Giving the upper hand of volatile anesthetics in the CABG surgeries and minimizing the use of intravenous anesthetics