ABSTRACT
PURPOSE: Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS: Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS: The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS: The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.
Subject(s)
Cardiotonic Agents/administration & dosage , Coronary Artery Disease/surgery , Methyl Ethers/administration & dosage , Myocardial Revascularization/methods , Platelet Aggregation Inhibitors/administration & dosage , Propofol/administration & dosage , Aged , Anesthetics, Intravenous/administration & dosage , Coronary Artery Disease/drug therapy , Female , Humans , Male , Middle Aged , Sevoflurane , Treatment OutcomeSubject(s)
Intraoperative Complications/therapy , Practice Guidelines as Topic , Scoliosis/surgery , Spinal Cord Injuries/therapy , Spinal Fusion/adverse effects , Adolescent , Adult , Algorithms , Child , Combined Modality Therapy , Contraindications , Drainage , Humans , Hypothermia, Induced , Internal Fixators/adverse effects , Intracranial Hypertension/etiology , Intracranial Hypertension/prevention & control , Intracranial Hypertension/surgery , Intraoperative Complications/drug therapy , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Ischemia/etiology , Ischemia/prevention & control , Ischemia/therapy , Methylprednisolone/therapeutic use , Monitoring, Intraoperative/methods , Monitoring, Intraoperative/statistics & numerical data , Neuroprotective Agents/therapeutic use , Spinal Cord/blood supply , Spinal Cord Injuries/drug therapy , Spinal Cord Injuries/etiology , Spinal Cord Injuries/prevention & controlABSTRACT
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