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Comparison of Haemodynamic and Cardiovascular Effects of VIMA with Sevoflurane Versus TIVA with Propofol in Patients Undergoing Coronary Artery Bypass Surgery

2008; Medknow; Volume: 52; Issue: 6 Linguagem: Inglês

0976-2817

Neerja Bharti, Pramila Chari, Shyam Kumar Singh Thingnam, Suman Arora,

Anesthesia and Neurotoxicity Research

Sevoflurane provides protection against myocardial ischaemia during bypass surgery. This prospective, random­ized study was conducted to compare the haemodynamic and cardiovascular effects of sevoflurane induction& maintenance of anaesthesia(VIMA) with a standard total intravenous technique using propofol(TIVA) during coro­nary artery bypass graft (CABG) surgery. Thirty adult patients undergoing elective CABG surgery were randomly allocated to receive either sevoflurane (S group) or propofol (P group) for induction and maintenance of anaesthesia. In both groups, analgesia was supple­mented with fentanyl and muscle relaxation with vecuronium. Patients' heart rate, systemic and pulmonary pressures, cardiac index and mixed venous oxygen saturation were measured at following time intervals: pre-induction, post­induction, post-intubation, skin incision, post sternotomy, chest closure, and 1 hr after surgery, at spontaneous respira­tion and post extubation. The type and duration of inotropic support, duration of postoperative ventilation and ICU stay, perioperative complications and outcome were assessed. Patients' characteristics and demographic data were similar for both groups. Induction of anaesthesia was rapid and smooth in all patients. Compared to sevoflurane group more patients in the propofol group required nitroglycerine(NTG) to control blood pressure during prebypass period. Patients receiving sevoflurane had higher cardiac index (P<0.05) and required less inotropic support during post-operative period as compared to propofol treated patients. Duration of postoperative ventilation and ICU stay was similar in both groups. The incidence of postoperative complications and outcome were comparable between groups. In conclusion, sevoflurane provided better perioperative haemodynamic control and cardiovascular profile than propofol during elective CABG surgery.