| Objective:1.To evaluate the application of volatile induction and maintenance of anesthesia with sevoflurane in patient undergoing off-pump coronary artery bypass grafting;2. To investigate the influence of volatile induction and maintenance of anesthesia with sevoflurane on postoperative cardiac enzymes and troponin in these patients;3. To observe the perioperative changes of MicroRNA-499and MicroRNA-208b in these patients.Methods:Thirty patients scheduled for the off-pump coronary artery bypass grafting were radomized into two groups(n=15) in XiangYa hospital from2011.05to2012.02. Sevo group(volatile induction and maintenance of anesthesia with sevoflurane) and Pro group(Total intravenous anesthesia with propofol).Sevo group:sevoflurane was used during anesthesia induction and maintenance. Pro group:The induction and maintenance of anesthesia used propofol instead of sevoflurane.The depth of anesthesia was guided by BIS40-50. Record HR、SBP、DBP、MAP、PAM at T1(before anesthesia induction),T2(before intubation),T3(after intubation) T4(beginning of operation),T5(opening chest),T6(after the first vessel grafted),T7(after the last vessel grafted),T8(closing thorax),T9(the end of operation),T10(after ICU arrival).RPP was calculated at each time point. Measure CO, CVP, PAM, PAW, CI, SV, SVR, SVRI, PVR, PVRI, LVSWI, RVSWI, EF and FS at the beginning and the end of operation. Record the dose of vasoactive drugs, ICU stay time, mechanical ventilation time and the incidence of arrhythmia, reoperation, admission to the ICU again. Intraoperative awareness was evaluated1day and4day postoperatively. The concentration of Troponin-I, creatine kinase-MB, CK, LDH, MicroRNA-499and MicroRNA-208b in blood samples, collected from the radial artery at predetermined intervals, was determined.Results:1. HR in two groups were not significantly different(P>0.05).HR is lower at the point of T4than T1in Pro group. MAP in two groups were not significantly different(P>0.05).MAP at the point of T5and T8is lower in Sevo group than in Pro group. RPP and PAM in two groups were not significantly different(P>0.05).2. There are higher postoperative CO in two groups. CO in two groups were not significantly different(P>0.05). CVP in two groups were not significantly different (P=0.025).Postoperative CVP is lower than preoperative. There are higher postoperative CI in two groups. CI in two groups were not significantly different(P>0.05). Postoperative CI and FS is higher than preoperative in Sevo group.There were not significantly different in two group about PAM, PAW, SV, SVR, SVRI, PVR, PVRI, LVSWI, RVSWI.3. There were no significantly difference about the amount of sufentanil vasoactive drug,ICU stay time, mechanical ventilation and the incidence of arrhythmia, reoperation, admission to the ICU again.All patients hadn’t experience intraoperative awareness.4. Paitents in Sevo group have lower CK-MB(P=0.026),but we didn’t find a significant difference about cTnI, CK-MB, LDH, CK. CK-MB at the point of T3is lower in Sevo group than that in Pro group (P=0.026). Postoperative CK-MB is higher than preoperative in Pro group (P<0.01).It Performanced lower Concentrations of MicroRNA-499(P=0.002) and MicroRNA-208b (p=0.043) in Sevo group. MicroRNA-499and MicroRNA-208b at the point of T3is lower in Sevo group than that in Pro group (P=0.026) Conclusion:1. Volatile induction and maintenance of anesthesia with sevoflurane guided by BIS had a stable Haemodynamics in patient undergoing off-pump coronary artery surgery. Compared to Pro group,it didn’t increase the amout of vasoactive drugs and the incidence of intraoperative awareness.2. Sevoflurane can reduce the release of cardiac markers such as CK, MicroRNA-499and MicroRNA-208b in patients undergoing off-pump coronary artery surgery in24hours Postoperatively.It suggested that sevoflurane can reduce myocardial injury and exert a apparent cardioprotection in patient undergoing off-pump coronary artery surgery when it was administered throughout the operation guided by BIS. |
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