Comparison of the Effects of Sevoflurane, Isoflurane, and Desflurane on Microcirculation in Coronary Artery Bypass Graft Surgery
Journal of Cardiothoracic and Vascular Anesthesia, 05/17/2012
Ozarslan NG et al. – Sevoflurane had a negative effect on the microcirculation. Isoflurane decreased vascular density and increased flow. Desflurane produced stable effects on the microcirculation. These inhalation agents induced transient alterations in microvascular perfusion.
Thirty patients undergoing elective CABG.
atients were assigned to sevoflurane, desflurane, or isoflurane.
Orthogonal polarization spectral imaging was used to evaluate the sublingual microcirculation.
Hemodynamic variables (heart rate, mean arterial pressure, central venous pressure, cardiac output, and pulmonary capillary wedge pressure), laboratory parameters (hematocrit, lactate, and potassium), and microcirculatory variables (total vascular density [TVD] [mm/mm2], microvascular flow index [MFI] [arbitrary units], perfused vessel density [PVD] [mm/mm2], and proportion of perfused vessels [PPV] [percentage] were obtained before induction, after induction, during cardiopulmonary bypass, at the end of surgery, and 24hours after surgery.
The greatest alterations in microcirculation parameters were found during cardiopulmonary bypass.
In the sevoflurane group, TVD (14.7%), PVD (22%), PPV (5.97%, p<0.05), and MFI (7.69%, p>0.05) were decreased.
In the isoflurane group, TVD (14.7%) and PVD (20.3%) were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p < 0.05).
In the desflurane group, there were no changes in TVD and PVD, but MFI (8.99%, p>0.05) and PPV (1.48%, p<0.05) were increased in the small vessels.
These changes returned to their initial values 24hours postoperatively.
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