Cardioprotective Effects Of Sevoflurane In Adults Undergoing Valve Replacement Surgery

Objective:To investigate the effects of sevoflurane combined intravenous anesthesia on myocardial enzyme and troponin I in patients undergoing cardiac valve replacement with cardiopulmonary bypass and to observe the myocardial protective effects of sevoflurane combined intravenous anesthesia.Methods:Forty-two ASA II or III patients undergoing cardiac valve replacement with cardiopulmonary bypass were randomly divided into three groups:Group I (group of total intravenous anesthesia),Group II (group of sevoflurane) or GroupⅢ(group of sevoflurane preconditioning and postconditioning)(14cases in each group). The anesthesia was induced with midazolam, etomidate, fentanyl and cisatracurium besilate and maintained with propofol and fentanyl combined with or without sevoflurane:Group I without sevoflurane, Group II with1%-3%sevoflurane, and GroupⅢ with1%-3%sevoflurane before and after cardiopulmonary bypass. The blood samples were taken5ml from central vein at3time points(5min after the intubation (TO),5min after extubation (T1) and18h (T2)after operation respectively) to determine levels of CK, CK-MB, LDH, LDH1, HBDH and cTn-I. The time of CPB, aortic clamping, operation, extubation were also recorded.Results:1. There were no significant differences in age, body weight, time of CPB, aortic clamping, operation duration, extubation among groups (p>0.05); 2. Compared with group of total intravenous anesthesia, cardioprotective effects were better and CK, LDH, LDH1, cTn-I lower in group of sevoflurane and group of sevoflurane preconditioning and postconditioning (p<0.05).3. No significant difference was detected in levels of CK-MB and HBDH among three groups(p>0.05).4. The level of HBDH at18hours after the surgery in group of sevoflurane preconditioning and postconditioning was significantly lower than that in group of sevoflurane (p<0.05).Conclusion:The cardioprotection effects afforded by sevoflurane combined with propofol intravenous anesthesia in patients undergoing valve replacement are better than those by total intravenous anesthesia.