Induction with midazolam (0.1–0.3 mg/kg) and fentanyl (5–15 g/kg), then a bolus of fentanyl 10 g/kg Iso: 2.3%; Sev: 4.1%. End-tidal concentrations of each anaesthetic vapor were kept less than 2.0 MAC equivalents
Myocardial infarction (assessed with CK-MB and ECG changes), ventricle failure, cardiac death, noncardiac death, and other hemodynamic events
Either Sev or Iso combined with fentanyl provided acceptable hemodynamic outcomes in patients with low risk who underwent elective CABG
Induction with midazolam (1-2 mg), fentanyl 3 g/kg, propofol as required and pancuronium 8 mg; then at sternotomy, fentanyl 4 g/kg and midazolam 1 mg MAC limits of 0.3 and 1.6 were used for Sev and Iso. In the crossover study, before surgery hemodynamic and cardiac profile were recorded at the following phases: (1) no volatile agent; (2) Iso 0.6%, Sev 0.9% (0.5 MAC); (3) Iso 1.2%, Sev 1.8%; (1.0 MAC); (4) no volatile agent; (5) Iso 0.6%, Sev 0.9% (0.5 MAC); (6) Iso 1.2, Sev 1.8 (1.0 MAC); (7) no volatile agent
Hemodynamic outcomes (HR, CI, SVRI, PVRI, SAP, PAP, CVP, and PCWP). Postoperative outcomes such as time of operation, time to open eyes, time of extubation, recall, memory, PONV, and general condition were also reported
Iso and Sev used as the primary anesthetic showed no statistical difference between them at any stage of the study
Induction with midazolam (1-2 mg), fentanyl 3 g/kg, propofol as required and pancuronium 8 mg; then at sternotomy, fentanyl 4 µg/kg and midazolam 3 mg In the crossover study the protocol used was the same as that of Bennett and Griffin 1999
Same hemodynamic outcomes as measured in Bennett and Griffin 1999 [10]. Postoperative outcomes such as time of operation, time to open eyes, time of extubation, inotrope infusion, use of vasodilators, PONV, and memory were reported as well
Sev showed a tendency to lower heart rates and cardiac index compared with Iso. Nonetheless, these findings have shown no significantly difference
3-arm (isoflurane, sevoflurane, or propofol), randomized, controlled trial with patients and intensive care staff blinded to the drug allocation
CABG
Iso: 118 Sev: 118 Pro: 118
Induction with fentanyl 10 g/kg, diazepam 0.1 mg/kg, and pancuronium 0.15 mg/kg. Then fentanyl 5 g/kg two minutes before sternotomy. During surgery, isoflurane (end-tidal concentration 0.5% to 2%), sevoflurane (end-tidal concentration 1% to 4%), or propofol (target concentration 1–8 g/mL)
Time to extubation, ICU stay, and perioperative hemodynamics and perioperative drugs administered
Time to tracheal extubation was significantly longer for the target-controlled propofol group; however a significantly greater number of patients in this group required the use of a vasodilator to control intraoperative hypertension
Before CPB: Group Iso: 1% to 1.5%; Group Sev: 1.5% to 2%; Group Des: 7% to 8% During CPB: Group Iso: 0.5% to 1%; Group Sev: 1%; Group Des: 4% to 5%
Plasmatic levels of S100 in different operative instances and neuropsychological tests such as Minimental State Examination and Visual-Aura Digit Span Test
Iso was associated with better neurocognitive functions than Des or Sev after on-pump CABG. Sev seems to be associated with the worst cognitive outcome as assessed by neuropsychological tests, and prolonged brain injury as detected by high S100 levels was seen with Des
Volatile agents were titrated to maintain hemodynamic variables within 20% of their baseline values. Both groups received fentanyl 5 g/kg
Time variables after the surgery (including duration of anesthesia, duration of surgery, time to extubation, and hospital LOS). Neuropsychological scores and troponin enzyme levels after the surgery were also measured
Both Sev and Iso may be safely used as maintenance agents in OPCAB. Sev has the advantage of allowing earlier extubation and evaluation of neuropsychological tests after OPCAB
Induction with thiopentone sodium, midazolam (0.05–0.1 mg/kg) and fentanyl citrate (4 g/Kg). Groups with Sev or Iso 0.5–2% till end-tidal concentration of agent of 1.5–2%. Then fentanyl (50 g) and vecuronium (1 mg) were repeated at regular interval of 1 hour until the end of the surgery
Hemodynamic data (HR, MAP, PAP, CI, and others), depth of anesthesia, ischemic changes (assessed through blood CK-MB levels and ECG changes), time of awakening, and time of extubation
Both anesthetics are safe. Sev provides early awakening and extubation as compared with Iso
Iso: induction: 1 g/kg bolus of remifentanil and midazolam 0.1 mg/kg, followed by a continuous infusion of 0.4 g/kg/min; maintenance: 0.3–0.6 g/kg/min of remifentanil and Iso 0.5%–1% Sev: induction: 1 g/kg bolus of remifentanil followed by a continuous infusion of 0.4 g/kg/min; Sev was started at 8% and when the patient was asleep lowered of 2%; maintenance: 0.3–0.6 g/kg per minute remifentanil and 0.5%–2% Sev Pro: induction: 1 g/kg bolus of remifentanil, followed by 0.4 g/kg/min and an infusion of propofol 2 g/mL; maintenance: 0.3–0.6 g/kg per minute remifentanil and 2–4 mg/mL infusion of propofol
Hemodynamic data (HR, MAP, PAP, CVP, PCWP, CO, CI, SVRI), myocardial oxidative stress status, and troponin I changes
Inhalation anesthetics preserved cardiac function in coronary surgery patients after CPB with less evidence for myocardial damage than propofol
Induction with fentanyl 3 mg/kg, followed by propofol 1-2 mg/kg. 1 MAC for each volatile agent for maintenance
Arterial blood gases, peak expiratory flow, hemodynamic data, myocardial protection (measured by blood levels of CK-MB and troponin-T), left ventricular ejection fraction, postoperative pain, and time of extubation
Both volatile agents offer the same myocardial protection but Sev was associated with a shorter time to extubation
Induction: intravenous midazolam 2 mg, fentanyl 3–5 mg/kg, and thiopentone 3–5 mg/kg Maintenance: boluses of fentanyl and midazolam in each group. Iso: 1 MAC; Sev: 1 MAC; TIVA: fentanyl 4 μg/kg/h, and midazolam 0.1 mg/kg/h
Hemodynamic data and S100 blood levels
S100 levels are diminished during Sev use in contrast to Iso and TIVA. The hemodynamic changes in the first 24 h do not seem to be influenced by these interventions
Induction: etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg, and remifentanil 1 g/kg was administered Maintenance: Sev: 2–4%; Iso: 1-2%. Both groups were started on a remifentanil infusion (0.1–0.4 g/kg/min)
Hemodynamic data. Troponin-T, CK, and CK-MB levels
Sev provides a better myocardial protection than Iso, with lower levels of troponin-T and CK-MB observed with Sev
Induction: etomidate 0.4 mg/kg, vecuronium bromide 0.1 mg/kg, and fentanyl, 1 g/kg Maintenance: Iso: 1%-2%; Sev: 2%-3%; Des: 4%–6%. All volatile agents were given at 1 MAC in an oxygen-air mixture, and remifentanil was at 0.025 mg/kg/min
Hemodynamic data, laboratory parameter (such as hematocrit, lactate and potassium), and microcirculatory parameters
Sev had a negative effect on the microcirculation. Iso decreased vascular density and increased flow. Des produced stable effects on the microcirculation. All inhalation agents induced transient alterations in microvascular perfusion
Induction: intravenous bolus infusion of midazolam (0.1 mg/kg), fentanyl (15–20 m/kg), and intravenous pancuronium bromide (0.1 mg/kg) Maintenance: doses of fentanyl 5 g/kg and pancuronium bromide 2 mg were applied repeatedly as required in this group. Sevoflurane or isoflurane was administrated in 1 MAC (minimal alveolar concentration)
Hemodynamic parameters, CK-MB, troponins, lactate
No significant differences between volatile agents
Induction: propofol 1-2 mg/kg, fentanyl 3–5 g/kg, and atracurium, 0.5 mg/kg Maintenance: propofol infusion 4–10 mg/kg/min. The vaporizer was set at a fixed fractional amount of Sev and Iso into the fresh gas supply of 1.8 and 0.8, respectively, at a flow rate of 2-3 L/min
Pharmacokinetics measurements, blood troponin levels, total dose of norepinephrine during MECC, intubation time, ICU LOS, hospital LOS, and mortality within 30 days
Similar pharmacokinetics regarding wash-in and wash-out for Sev and Iso. No significantly differences in cardiovascular stability and markers of cardiac damage were found
CABG, CPB, and/or single valve repair or replacement
Iso: 233 Sev: 231
Induction: fentanyl (5–10 μg/kg) or sufentanil (1–5 μg/kg), midazolam (0.05–0.1 mg/kg), propofol (0.25–1 mg/), and rocuronium (0.6–1.2 mg/kg). Both volatile agents were administered at a dose of 0.5–2.0 MAC throughout the entire operation
ICU LOS, mortality, troponin T levels, ICU lengths of stay, duration of tracheal intubation, inotrope or vasopressor usage in the ICU, inotrope or vasopressor usage, peak postoperative serum creatinine, new-onset hemodialysis, new-onset atrial fibrillation, use of an intra-aortic balloon pump, perioperative stroke, and ICU readmission
Sev is noninferior to isoflurane on a composite outcome of prolonged ICU stay and mortality. Sev is not superior to Iso on any other of the clinically important outcomes
