체외순환 없는 관상동맥 우회술시 Sevoflurane-remifentanil과 midazolam-sufentanil 전정맥마취의 심근보호효과의 비교 (Comparison of cardioprotection between sevoflurane-remifentanil and midazolamsufentanil total intravenous anesthesia during off-pump coronary artery bypass surgery)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Anesthesia and Pain Medicine / 7권 / 4호 / 320 ~ 324페이지
· 저자명 : 길남수, 손윤정, 황진영, 최승표, 심성은, 허진, 민성원, 김종수, 전윤석, 이수영

초록

Background: Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review.
Methods: The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68),and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical,anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured.
Results: All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover,there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1−5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009),3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively).
Conclusions: Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG.

영어초록

Background: Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review.
Methods: The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68),and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical,anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured.
Results: All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover,there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1−5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009),3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively).
Conclusions: Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG.

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