Objective: Evaluation of cardioprotective effects of sevoflurane compared with propofol in high-risk cardiac patients undergoing non-cardiac surgery.
Material and methods: Prospective study enrolling 14 patients with cardiac risk Lee’s score > 3 points, undergoing abdominal elective surgery. The patients were divided into two groups: Group S (sevoflurane) – 8 patients who received balanced anesthesia with sevoflurane; Group P (propofol) – 6 patients receiving total intravenous anesthesia – target control infusion (TIVA-TCI). All patients were monitored hemodynamically, cardiac biomarkers (troponine I – TnI, the precursor of brain natriuretic peptide – proBNP, myocardial creatine kinase – CKMB) and inflammatory tests (high sensitive C-reactive protein – CRP, fibrinogen – FBG, interleukin 6 – IL6) were registered perioperatively.
Results: All patients had a decrease of mean arterial pressure (MAP) after induction, with significant values in Group P (48.4±3.82 mmHg). There were no acute cardiac perioperative events and the concentration of TnI after surgery was significantly lower in patients with sevoflurane anesthesia ( 0.017±0.01 ng/ml vs. 0.2±0.18 ng/ml) at 12 h and 24 h respectively (p <0.05). CKMB had lower postoperative values in Group S vs. Group P. ProBNP was elevated preoperatively in all patients and it is correlated with increased cardiac risk. In postoperative period the patients have lower levels in Group S compared with Group P (p <0.05). IL6 showed a significant decrease in patients in Group P at 12–48 h after surgery.
Conclusion: Anesthesia with sevoflurane, in patients with increased cardiac risk undergoing non-cardiac surgery, was accompanied by decreased values of TnI, proBNP and CKMB postoperatively, compared with propofol anesthesia.