Desflurane Versus Propofol Anesthesia for Off-Pump CABG

Comparison of Desflurane and Propofol Anesthesia for Off-Pump Coronary Artery Bypass Grafting Surgery

The purpose of this study is to prove if anesthesia maintained with the inhaled volatile anesthetic desflurane is superior to the intravenously applied propofol anesthesia in off-pump coronary artery bypass grafting (OP-CABG) surgery as measured by following parameters: hemodynamic parameters during and after the operation, pulmonary gas exchange, need for mechanical ventilation and for ICU and intrahospital stay, release of heart muscle injury markers in response to surgery and intraoperative ischaemia, inflammatory response to the operation. We suspect that insufflation anesthesia with desflurane may be superior to intravenous anesthesia with propofol.

General anesthesia will be induced by intravenous dosis of fentanyl, vecuronium and etomidate and further maintained either by inhaled desflurane or propofol infusion, with concomitant empirically administered fentanyl doses and continuous infusion of vecuronium. After induction of anesthesia a Swan-Ganz catheter for continuous cardiac output, right ventricle end diastolic volume and blood saturation measurements will be introduced through the internal jugular vein. A transesophageal echocardiography probe will be placed additionally for the Tei-index measurement. Hemodynamic parameters will be recorded at the following time points: before induction after induction during trachea intubation before skin incision 3 Min. after skin incision after sternotomy before heart positioning for graft placing before finishing placing each distal anastomoses 10, 20, 30, 40 min after placing the last anastomoses 10 Min. after admission to ICU, 6, 12, 18 and 24 hours after surgery. TEE measurements will be obtained after sternotomy and 20 Min after placing the last distal anastomoses. The results will be compared while using the parametric ANOVA test for normally distributed continuous data or the nonparametric Kruskal-Wallis/Wilcoxon-U test for categoric or inhomogeneous distributed continuous data.

anesthesia intravenous, propofol, anesthesia inhalation, desflurane, heart surgery, coronary artery by-pass off-pump, hemodynamic processes, anesthesia

a vapor concentration of 3-7 vol% is maintained with use of vaporizer and under control of arterial blood pressure, heart rate, and BIS index.

Markers of heart muscle injury and inflammation will be compared: troponin I, creatinine phosphokinase and its heart specific fraction, C-reactive protein.

Evidence of clinically definite heart infarct confirmed by ECG and/or echocardiography, and heart muscle specific creatinine phosphokinase increase.

Inclusion Criteria: Patients with coronary artery disease qualified for CABG off-pump surgery Elective surgery Signed informed consent Exclusion Criteria: Left ventricle ejection fraction < 30% Serum creatinine > 2 mg/dL Emergency surgery Denied consent

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