Myocardial Injury in Remifentanil-Based Anaesthesia for off-Pump Coronary Artery Bypass Surgery: An Equipotent Dose of Sevoflurane versus Propofol

Abstract

This randomised controlled trial compared the effect of equipotent anaesthetic doses of sevoflurane (S group) versus propofol (P group), during remifentanil-based anaesthesia for off-pump coronary artery bypass surgery, on myocardial injury. Either sevoflurane or propofol was titrated to maintain bispectral index values between 40 and 50. In both groups, a targeted concentration of remifentanil 20 ng.ml^-1 was maintained during anaesthesia. The concentrations of creatine kinase MB and troponin I were measured before the start of surgery, on admission to the intensive care unit, and at 12 and 24 hours after intensive care unit admission. The postoperative values of creatine kinase MB (S group: 15.08±18.97, 20.78±20.92, 12.76±12.82 vs 2.09±1.54 ng.ml^-1; P group: 10.99±13.15, 27.16±56.55, 11.88±18.80 vs 1.84±1.67 ng.ml^-1) and troponin I (S group: 3.56±5.19, 5.66±7.89, 3.35±4.55 vs 0.52±1.90 ng.ml^-1; P group: 2.42±3.33, 4.11±6.01, 3.04±5.31 vs 0.43±1.28 ng.ml^-1) were significantly higher than preoperative values in both groups but there were no significant differences between the two groups. There were no significant differences in time to extubation (S group, 476±284 minutes; P group, 450±268 minutes) and intensive care unit length of stay (S group, 2775±1449 minutes; P group, 2797±1534 minutes) between the two groups. In conclusion, sevoflurane and propofol at equipotent doses guided by bispectral index with remifentanil 20 ng.ml^-1 had similar creatine kinase MB and troponin I values.