Comparative Study of Sevoflurane Versus Desflurane on Hemodynamics in Off Pump Coronary Artery Bypass Grafting
Author(s): Indu Verma, Chandan Verma, Ramnaresh Sharma, Sandeep Dhaked
Background: Volatile anesthetics like sevoflurane and desflurane have been used in various cardiac surgeries with a purpose of myocardial protection, renal protection, and early extubation. Maintaining hemodynamics during off pump coronary artery bypass grafting (OPCABG) is challenging for cardiac anesthesiologists. We compared desflurane and sevoflurane in patients undergoing OPCABG.
Methods: A sample size of 148 patients were randomly allocated into two groups after permission from the institutional ethical committee and review board with written and informed consent from each patient. Patients with ASA grade 3 and 4 between the age group 30-60 yrs of either sex, having ejection fraction (EF) >40% undergoing coronary artery bypass grafting under general anesthesia were included in the study. Patients with anticipated difficult intubation, compromised renal and pulmonary function, hypersensitive to drugs used in the study, with altered coagulation profile, diabetes mellitus, obesity, left ventricular ejection fraction <40%, with severe cardiac arrhythmias were excluded from the study.
Results: The primary outcomes included the heart rate, mean arterial pressure, cardiac output, cardiac index, and systemic vascular resistance from baseline 15, 30, 45 and 60 minutes after intubation and 1 hour after surgery. The secondary outcomes included CPK-MB, blood urea, and serum Creatinine and any other side effect 24 hrs postoperatively. There was an increase in the heart rate just after induction and 15 minutes post intubation in the sevoflurane group as compared to the desflurane group with a p value of 0.0001 and 0, 0006 which is statistically significant. There was a statistically significant decrease in the mean arterial blood pressure in the desflurane group with a p value of 0.0001 and 0.001. Cardiac output increased in the desflurane group 30, 45 and 60 minutes after intubation with a p value of 0.04, 0.008 and 0.006 which was statistically significant. Systemic vascular resistance also decreased in the desflurane group with a p value of 0.019 and 0.011. But sevoflurane showed decreased CPK-MB levels 46.61 ± 21.90 S.D as compared to 50.49 ± 26.29 S.D in the desflurane after 24 hrs postoperstively which was not statistically significant . Blood urea and serum Creatinine were also elevated in the desflurane group.
Conclusion: During the crucial period of off pump coronary artery bypass grafting the maintenance of hemodynamic stability was better seen with desflurane as compared to sevoflurane and is suggested to be used for better outcome of patients.