| Objective: To compare the influence of wholesevoflurane inhaling or target-controlled infusion of propofol for thecardiac troponin I, creatine kinase and lactate during induction ofanesthesia and perioperation; to explore the applicability of the twomethods in heart valve replacement surgery and compare theirmyocardial protective effect. Methods:30adult patients who wentthrough heart valve replacement surgery with cardiopulmonary bypass inPeople’s Hospital of Sichuan Province between September2011andJanuary2012were included, with12males and18females, aged35-66,ASA staging II-III, cardiac function classification (NYHA) II-III. All thepatients were classified into intervention group (sevoflurane group, Sgroup) and control group (propofol group, P group) by computergenerated random number. Patients had no pre-operative medicine, andhad intravenous midazolam1mg after entering the operation room andbefore anesthetic induction, and had radial artery, the right internaljugular vein puncture under local anesthesia, and invasive arterial bloodpressure, central venous pressure, five-lead ECG, pulse oximetry, end-tidal carbon dioxide partial pressure, BIS were monitored. S groupgot1%sevoflurane (fresh gas flow6L/min) with concentration of thevaporizer increase1%until3%with1minute interval during anestheticinduction. P group got target-controlled infusion of propofol duringanesthetic induction, the initial target plasma concentration was set at0.8ug/ml, and the concentration increase0.5ug/ml every minute untilintubation. All the patients got fentanyl5ug/kg, rocuronium0.6mg/kg,and intubation was conducted when BIS decreased lower than60andmean arterial pressure (MAP)<20%basic MAP. During anesthesiamaintaince, patients got0.5-2MAC sevoflurane inhaling ortarget-controlled infusion of propofol2-4ug/ml, with discontinuousintravenous fentanyl and rocuronium, and maintained BIS40-60, MAP<±20%basic MAP, central venous pressure5-15cmH2O. Outcomevariables included demographic characteristics of the patients, such asgender, age, weight, type of surgery, aortic cross-clamping time,cardiopulmonary bypass (CBP) time, wake time, extubation time, ICUstay time and the dosage of fentanyl and vasoactive drugs duringperi-operation. The following parameters were also recorded, systolicblood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) andBIS value in before anesthetic induction (T0), induction1minute (T1),induction2minutes (T2), induction3minutes (T3), induction5minutes(T4), intubation (T5),3minutes after intubation (T6) and10minutes after intubation (T7), and blood glucose in T2, T3, T7, and cardiac troponin I(cTnI), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) andlactate (LAC) in T0, aortic inbation (T8),30minutes after aorta opening(T9),6hours after aorta opening (T10),24hours after aorta opening (T11).Results: All the included patients went through the trial, there was nowas no adverse reactions and discharged healthly. There was no statisticaldifference on gender, age, weight, type of surgery, aortic cross-clampingtime, cardiopulmonary bypass (CBP) time, wake time, extubation time,ICU stay time and the dosage of fentanyl and vasoactive drugs duringperi-operation between the two groups (P>0.05). And there was nostatistical difference on SBP, DBP, HR and blood glucose duringanesthetic induction (P>0.05). The intergroup comparison showed thatSBP decreased significantly on T1-T7compared to T0(P<0.05) anddecrease more significantly on T3-T7(P<0.01); DBP, HR decreasedsignificantly during T3-T7compared to T0(P<0.05) and the blood glucosehad no significant change (P>0.05); The pre-opertaive cTnI, CK, CK-MBand LAC were within the normal range, but increased siginicantly on T9and T10、 T11， and was more significant on T10(P<0.01) between twogroups, and the intra-group comparion showed no difference on othertime points. Conclusion: The use of gradient method sevofluraneinhaling and target-controlled infusion of propofol during anestheticinduction for adult heart valve replacement surgery had somewhat influence to the hemodynamics but such influence was clinically acceptedand they could decrease intubation stress response which could make abetter intubation. When myocardial injury markers used as myocardialprotection outcome variables, whole sevoflurane inhaling could notreduce the release of cTnI compared to propofol TIVA in heart valvereplacement surgery. |
PDF Full Text Request