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.Methods
- 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.