Comparison Of The Myocardial Protection Of Etomidate And Propofol In Patients With Open Heart Surgery During Cardiopulmonary Bypass.

OBJECTIVE:Patients undergoing open heart surgery with cardiopulmonary bypass(CPB) were used etomidate or propofol sedation, whose experimental data, such as intraoperative hemodynamic changes,systemic inflammatory response,lipid peroxidation and cortisol, were compared. Whether etomidate has a myocardial protection that will provide a theoretical and experimental data.METHODS:1. Forty patients with heart disease were enrolled in the study. They were divided randomly into 2 groups (n=20 each): etomidate group(E group)and propofol group (P group).There were no differences between two groups about medication during perioperative except that the etomidate was used for anesthesia induction and maintenance in E group while the propofol was used in P group.2. HR,SBP,DBP,MAP and CVP were monitored and recorded immediately about two group before anesthesia induction, 1min after induction, 5min after intubation, 1min after incision, 5min after incision, 1min after sternotomy, 5min after sternotomy, before CPB, before aortic occlusion, 5min after aortic, shutdown, the end of surgery and 24 hour after surgery.3. Before anesthesia induction, after intubation, 5min after aortic, shutdown, 4 hour after shutdown and 24 hour after surgery, blood samples were collected to measure the level of TNF-α,IL-6,IL-8 and IL-10 about two group.4. Before anesthesia induction, after intubation, 5min after aortic, shutdown, 4 hour after shutdown and 24 hour after surgery, blood samples were collected to measure MDA and SOD about two group.5. Cortisol were monitored at preoperative and 24 hour after surgery.RESULTS:1. There were no significant differences between groups at baseline. A significantly greater decrease of SBP,DBP and MAP (P<0.01)was observed in 1min after induction, but P group was a greater decrease than E group (P<0.01). 5min after sternotomy, the two group of blood pressure maintained at normal levels ,there were significant differences about SBP between groups (P<0.01). Before CPB, the two groups of SBP,DBP and MAP decreased, P group was a greater decrease than E group about SBP (P<0.01). 1min and 5min after incision, the two groups of HR had a greater decrease than baseline about HR (P<0.05), but there were no significant differences between groups (P>0.05).2. TNF-α,IL-6,IL-8 and IL-10 were increased gradually during CPB, and peaked at shutdown (P<0.01). The two groups of TNF-α,IL-6 and IL-8 was no significantly difference in the period (P>0.05).5min after aortic and shutdown, P group of IL-10 was significantly higher than E group, there are significant differences between groups (P<0.01).3. The two groups of MDA gradually increased and peaked at 4 hour after shutdown during CPB (P<0.05), E group of MDA was significantly higher than P group, there are significant differences between groups (P<0.05). The two groups of SOD also gradually increased and peaked at shutdown during CPB (P<0.05), there are no significant differences between groups (P>0.05).4. P group of plasma cortisol had significantly increased at 24 hours after surgery (P <0.01). E group was maintained at the levels before anesthesia.CONCLUSIONS:1. Etomidate which was used as a sedation of patients undergoing open heart surgery with CPB maintained more stable than propofol on hemodynamics.2. Both of etomidate and propofol can reduce systemic inflammation and lipid peroxidation for patients with impaired heart function, but propofol was stronger than etomidate on myocardial protection.