Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials

doi:10.1053/j.jvca.2007.02.013

Journal of Cardiothoracic and Vascular Anesthesia

Volume 21, Issue 4, August 2007, Pages 502-511

https://doi.org/10.1053/j.jvca.2007.02.013 Get rights and content

Objectives: The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery.

Background: It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans.

Methods: Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality.

Results: The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88).

Conclusions: Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.

Section snippets

Methods

Pertinent studies were independently searched in BioMedCentral and PubMed (updated January 30, 2006) by 4 trained investigators (G.L., O.F., E.B., and S.D.). The full PubMed search strategy was developed according to Biondi-Zoccai et al³⁹ and is available in Appendix 1. Further hand or computerized searches involved the recent (2002-2006) conference proceedings from the International Anesthesia Research Society, American Heart Association, American College of Cardiology, American Society of

Results

Database searches, snowballing, and contacts with experts yielded a total of 506 citations. Excluding 445 nonpertinent titles or abstracts, the authors retrieved 65 studies in complete form and assessed according to the selection criteria. A total of 43 studies were further excluded because of their nonexperimental design, including the use of historic controls, or because of duplicate publication. Specifically, 14 studies were excluded because of duplicate publication either explicitly

Discussion

A meta-analysis of pooled data from several small studies was performed and showed that desflurane and sevoflurane significantly decreased the rate of MI and death in patients undergoing cardiac surgery. Although significantly underpowered, most studies included in this analysis showed positive trends, consistent with the overall positive results of the meta-analysis. This is the first time that the choice of an anesthetic regimen has been shown to have an impact on patient outcomes after

Acknowledgment

This study is part of a senior training project of the Center for Overview, Meta-analysis, and Evidence-based Medicine Training (COMET), based in Milan, Italy (http://www.comet.gs). The current authors thank the authors of the trials included in this review who answered our questions. Thanks also to Giardina Giuseppe, RN, Antonioni Giliola, RN, Mella Francesca, RN, Castelnuovo Lara, RN, Pandi Frederic, RN, Zarantonello Sabrina, RN, Costantini Marco, RN, Castello Adams, RN, and Carminati Nicola,

References (92)

P. Chiari et al.
Anaesthetic-induced myocardial preconditioning: Fundamental basis and clinical implications
Ann Fr Anesth Reanim
(2005)
S.G. De Hert
The concept of anaesthetic-induced cardioprotection: Clinical relevance
Best Pract Res Clin Anaesthesiol
(2005)
J.A. Symons et al.
Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: A meta-analysis
Br J Anaesth
(2006)
B. Preckel et al.
Effects of enflurane, isoflurane, sevoflurane and desflurane on reperfusion injury after regional myocardial ischaemia in the rabbit heart in vivo
Br J Anaesth
(1998)
V. Piriou et al.
Pharmacological preconditioning: Comparison of desflurane, sevoflurane, isoflurane and halothane in rabbit myocardium
Br J Anaesth
(2002)
T.M. Skeehan et al.
Comparison of the alteration of cardiac function by sevoflurane, isoflurane, and halothane in the isolated working rat heart
J Cardiothorac Vasc Anesth
(1995)
F. Guarracino et al.
Myocardial damage prevented by volatile anestheticsA multicentre randomized controlled study
J Cardiothorac Vasc Anesth
(2006)
J.D. Law-Koune et al.
Sevoflurane-remifentanil versus propofol-remifentanil anesthesia at a similar bispectral level for off-pump coronary artery surgery: No evidence of reduced myocardial ischemia
J Cardiothorac Vasc Anesth
(2006)
N.D. Nader et al.
Anesthetic myocardial protection with sevoflurane
J Cardiothorac Vasc Anesth
(2004)
R.S. Parsons et al.
Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery
Br J Anaesth
(1994)

B. Pouzet et al.

Is there a place for preconditioning during cardiac operations in humans?

Ann Thorac Surg

(2002)

D. Moher et al.

Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statementQuality of Reporting of Meta-analyses

Lancet

(1999)

S. Lorsomradee et al.

Effects of sevoflurane on biomechanical markers of hepatic and renal dysfunction after coronary artery surgery

J Cardiothorac Vasc Anesth

(2006)

F.C. Parker et al.

Time to tracheal extubation after coronary artery surgery with isoflurane, sevoflurane, or target-controlled propofol anesthesia: A prospective, randomized, controlled trial

J Cardiothorac Vasc Anesth

(2004)

C. Garcia et al.

Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery

Br J Anaesth

(2005)

N.D. Nader et al.

Inclusion of sevoflurane in cardioplegia reduces neutrophil activity during cardiopulmonary bypass

J Cardiothorac Vasc Anesth

(2006)

T. Kawamura et al.

Effects of sevoflurane on cytokine balance in patients undergoing coronary artery bypass graft surgery

J Cardiothorac Vasc Anesth

(2006)

K. Nandate et al.

Effects of isoflurane, sevoflurane and propofol anaesthesia on jugular venous oxygen saturation in patients undergoing coronary artery bypass surgery

Br J Anaesth

(2000)

B. Mets et al.

Desflurane pharmacokinetics during cardiopulmonary bypass

J Cardiothorac Vasc Anesth

(2001)

K.F. Cheong et al.

Sevoflurane-fentanyl versus etomidate-fentanyl for anesthetic induction in coronary artery bypass graft surgery patients

J Cardiothorac Vasc Anesth

(2000)

G.N. Djaiani et al.

Vital capacity inhalation induction with sevoflurane: An alternative to standard intravenous induction for patients undergoing cardiac surgery

J Cardiothorac Vasc Anesth

(2001)

M. Filipovic et al.

Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation

Br J Anaesth

(2005)

A. Meiser et al.

Desflurane compared with propofol for postoperative sedation in the intensive care unit

Br J Anaesth

(2003)

S. Sator-Katzenschlager et al.

Sevoflurane and propofol decrease intraocular pressure equally during non-ophthalmic surgery and recovery

Br J Anaesth

(2002)

B. Preckel et al.

Pharmacology of modern volatile anaesthetics

Best Pract Res Clin Anaesthesiol

(2005)

J.A. Bennett et al.

Desflurane controls the hemodynamic response to surgical stimulation more rapidly than isoflurane

J Clin Anesth

(1995)

G.G.L. Biondi-Zoccai et al.

Long-term benefits of an early invasive management in acute coronary syndromes significantly depend on intracoronary stenting and aggressive antiplatelet treatment: A metaregression

Am Heart J

(2005)

K.A. Eagle et al.

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Circulation

(2004)

S. Slogoff et al.

Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations

Anesthesiology

(1989)

K.J. Tuman et al.

Does choice of anesthetic agent significantly affect outcome after coronary artery surgery?

Anesthesiology

(1989)

S.G. De Hert et al.

Cardioprotection with volatile anesthetics: Mechanisms and clinical implications

Anesth Analg

(2005)

S.G. De Hert

Volatile anesthetics and cardiac function

Semin Cardiothorac Vasc Anesth

(2006)

P.S. Myles et al.

Myocardial preconditioning with volatile anesthetic agents during coronary artery bypass surgery: A meta-analysis

Anesthesiology

(2005)

C. Yu et al.

Ischemic preconditioning with volatile anesthetics in CABG: A meta-analysis

Can J Anaesth

(2005)

C.H. Yu et al.

The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: A meta-analysis

Can J Anaesth

(2006)

J.C. Hartman et al.

Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs

Can J Anaesth

(1992)

N.R. Searle et al.

Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgerySevoflurane Venture Group

Can J Anaesth

(1996)

B. Bein et al.

Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery

Anesth Analg

(2005)

P.F. Conzen et al.

Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery

Anesthesiology

(2003)

S.G. De Hert et al.

Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration

Anesthesiology

(2004)

S.G. De Hert et al.

Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass

Anesthesiology

(2004)

S.G. De Hert et al.

Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients

Anesthesiology

(2003)

S.G. De Hert et al.

Sevoflurane but not propofol preserves myocardial function in coronary surgery patients

Anesthesiology

(2002)

S.R. El Azab et al.

Induction and maintenance of anaesthesia with sevoflurane in comparison to high-dose opioid during coronary artery bypass surgery

Eur J Anaesthesiol

(2000)

J. Frassdorf et al.

Sevoflurane-induced preconditioning: evaluation of two different protocols in humans undergoing coronary artery bypass grafting (CABG)

Anesthesiology

(2005)

N.R. Gravel et al.

Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery

Can J Anaesth

(1999)

Cited by (292)

Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis
2023, Medicina Intensiva
To comprehensively assess peer-reviewed studies using volatile (VA) or intravenous (i/v) anesthetics for sedation in intensive care units (ICUs), with the hypothesis that the type of sedation may have an impact on survival and other clinically relevant outcomes.
Systematic review and meta-analysis of randomized and non-randomized trials.
ICUs.
Critically ill and postoperative patients.
None.
Studies comparing VA versus i/v anesthetics used in the ICU settings were independently systematically searched. Finally, 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96 h) were included. VA had no impact on all-cause mortality (very low quality of evidence, Odds Ratio = 0.82 [0.60–1.12], p = 0.20). However, VA were associated with a reduction in duration of mechanical ventilation (p = 0.03) and increase in ventilator-free days (p < 0.001). VA also reduced postoperative levels of cardiac troponin (24 h), time to extubation (p < 0.001) and awakening (p = 0.04).
In this meta-analysis, volatile sedation vs propofol caused the increase in ventilator-free days, the reduction in the duration of mechanical ventilation, time to extubation and the troponin release in medical or surgical ICU patients, while in surgical ICU patients the time to awakening was shortened.
Evaluar exhaustivamente los estudios revisados por pares que utilizan anestésicos volátiles (AV) o intravenosos (iv) para sedación en unidades de cuidados intensivos (UCI), con la hipótesis de que el tipo de sedación puede tener un impacto en la supervivencia y otros resultados clínicamente relevantes.
Revisión sistemática y metaanálisis de ensayos aleatorizados y no aleatorizados.
UCI.
Se incluyeron críticamente enfermos y postoperatorios.
Ninguna.
Los estudios que comparaban los AV vs. los anestésicos iv utilizados en la UCI se buscaron de forma independiente y sistemática. Finalmente, se incluyeron 15 estudios (1.520 pacientes de perfil predominantemente quirúrgico necesitaron sedación de AV durante menos de 96 h). El AV no tuvo impacto en la mortalidad por cualquier causa (calidad de los datos probatorios muy baja, Odds Ratio = 0,82 [0,60-1,12], p = 0,20). Sin embargo, el AV se asoció con una reducción de la duración de la ventilación mecánica (p = 0,03) y aumento de los días sin ventilación mecánica (p < 0,001). La AV también redujo los niveles postoperatorios de troponina cardíaca (24 horas), el tiempo hasta la extubación (p < 0,001) y el despertar (p = 0,04).
En este metaanálisis, la sedación volátil vs. propofol causó el aumento de los días sin ventilación, la reducción de la duración de la ventilación mecánica, el tiempo hasta la extubación y la liberación de troponina en pacientes de la UCI médica o quirúrgica, mientras que en pacientes de la UCI quirúrgica el tiempo hasta el despertar se acortó.
Effects of sevoflurane and its metabolite hexafluoroisopropanol on hypoxia/reoxygenation-induced injury and mitochondrial bioenergetics in murine cardiomyocytes
2023, BJA Open
The volatile anaesthetic sevoflurane protects cardiac tissue from reoxygenation/reperfusion. Mitochondria play an essential role in conditioning. We aimed to investigate how sevoflurane and its primary metabolite hexafluoroisopropanol (HFIP) affect necrosis, apoptosis, and reactive oxygen species formation in cardiomyocytes upon hypoxia/reoxygenation injury. Moreover, we aimed to describe the similarities in the mode of action in a mitochondrial bioenergetics analysis.
Murine cardiomyocytes were exposed to hypoxia (0.2% O₂ for 6 h), followed by reoxygenation (air with 5% CO₂ for 2 h) in the presence or absence sevoflurane 2.2% or HFIP 4 mM. Lactate dehydrogenase (LDH) release (necrosis), caspase activation (apoptosis), reactive oxygen species, mitochondrial membrane potential, and mitochondrial function (Seahorse XF analyser) were measured.
Hypoxia/reoxygenation increased cell death by 44% (+31 to +55%, P<0.001). Reoxygenation in the presence of sevoflurane 2.2% or HFIP 4 mM increased LDH release only by +18% (+6 to +30%) and 20% (+7 to +32%), respectively. Apoptosis and reactive oxygen species formation were attenuated by sevoflurane and HFIP. Mitochondrial bioenergetics analysis of the two substances was profoundly different. Sevoflurane did not influence oxygen consumption rate (OCR) or extracellular acidification rate (ECAR), whereas HFIP reduced OCR and increased ECAR, an effect similar to oligomycin, an adenosine triphosphate (ATP) synthase inhibitor. When blocking the metabolism of sevoflurane into HFIP, protective effects of sevoflurane – but not of HFIP – on LDH release and caspase were mitigated.
Together, our data suggest that sevoflurane metabolism into HFIP plays an essential role in cardiomyocyte postconditioning after hypoxia/reoxygenation injury.
Effect of Volatile Anesthesia Versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial
2022, Journal of Cardiothoracic and Vascular Anesthesia
The purpose of this study was to evaluate the effect of volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on postoperative pulmonary complications (PPCs) among patients undergoing cardiac surgery.
Parallel-group, randomized controlled trial.
Single-center tertiary care hospital.
Five hundred twenty-four patients undergoing cardiac surgery with cardiopulmonary bypass.
The patients were assigned randomly (1:1) to receive anesthesia maintenance with a volatile anesthetic (sevoflurane or desflurane) or propofol-based TIVA.
The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days. The PPCs occurred in 118 of 262 patients (45.0%) in the volatile anesthesia group compared with 105 of 262 patients (40.1%) in the propofol-based intravenous anesthesia group (relative risk: 1.17 [95% CI 0.96-1.42], p = 0.123). There were no significant differences in the severity of PPCs within 7 days postoperatively, the occurrence and severity grade of PPCs within 30 days, the incidence of hypoxia, and 30-day mortality.
In adult patients undergoing cardiac surgery with cardiopulmonary bypass, general anesthesia with a volatile anesthetic compared with propofol-based TIVA had not reduced pulmonary complications within the first 7 days after surgery.
Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial
2022, Journal of Cardiothoracic and Vascular Anesthesia
To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG).
A post hoc analysis of a randomized trial.
Cardiac surgical operating rooms.
Patients undergoing elective, isolated CABG.
Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes.
A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03).
An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
2022, Journal of the American College of Cardiology
The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use.
A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered.
Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients’ interests.
Cardiac Effects of Anesthetic Agents That May Be Used in Labor and Delivery
2022, Maternal Cardiac Care: A Guide to Managing Pregnant Women with Heart Disease
Obstetric patients with cardiac disease present unique challenges and considerations for anesthesiologists during the peripartum period. This chapter reviews the medication classes most often encountered during this time and their potential effects on the cardiovascular system. In the setting of neuraxial anesthesia, the dense sympathectomy that can occur with local anesthetics must be considered and can be especially problematic for those with preload-dependent lesions or lesions relying on optimal coronary perfusion. When general anesthesia is indicated, anesthetic medications should be selected with care taking both the pregnant state and the patient’s cardiac condition into account. This chapter explores the most common cardiovascular effects of benzodiazepines, opiates and opioids, anesthetic induction agents, volatile anesthetics, nitrous oxide, neuromuscular blockers, and reversal agents, as well as antiemetics. With a more complete understanding of the medications encountered and their physiologic effects, the anesthesiologist can be better equipped to safely manage this patient population in the peripartum period.

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: Six authors acknowledge receiving drugs (A. Zangrillo by Baxter [desflurane]), reimbursement for conferences-simposia (G. Landoni, F. Guarracino, L. Tritapepe, S. De Hert, all by Abbott [sevoflurane]), or a research grant (G. Torri by Abbott) or honoraria for writing a CD on sevoflurane (F. Guarracino, L. Tritapepe, by Abbott). All 6 authors received modest support with the exception of G. Torri.

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Original articleDesflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials

Section snippets

Methods

Results

Discussion

Acknowledgment

Ann Fr Anesth Reanim

Best Pract Res Clin Anaesthesiol

Br J Anaesth

Br J Anaesth

Br J Anaesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

Br J Anaesth

Ann Thorac Surg

Lancet

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

Br J Anaesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

Br J Anaesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

J Cardiothorac Vasc Anesth

Br J Anaesth

Br J Anaesth

Br J Anaesth

Best Pract Res Clin Anaesthesiol

J Clin Anesth

Am Heart J

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Circulation

Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations

Anesthesiology

Does choice of anesthetic agent significantly affect outcome after coronary artery surgery?

Anesthesiology

Cardioprotection with volatile anesthetics: Mechanisms and clinical implications

Anesth Analg

Volatile anesthetics and cardiac function

Semin Cardiothorac Vasc Anesth

Myocardial preconditioning with volatile anesthetic agents during coronary artery bypass surgery: A meta-analysis

Anesthesiology

Ischemic preconditioning with volatile anesthetics in CABG: A meta-analysis

Can J Anaesth

The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: A meta-analysis

Can J Anaesth

Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs

Can J Anaesth

Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgerySevoflurane Venture Group

Can J Anaesth

Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery

Anesth Analg

Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery

Anesthesiology

Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration

Anesthesiology

Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass

Anesthesiology

Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients

Anesthesiology

Sevoflurane but not propofol preserves myocardial function in coronary surgery patients

Anesthesiology

Induction and maintenance of anaesthesia with sevoflurane in comparison to high-dose opioid during coronary artery bypass surgery

Eur J Anaesthesiol

Sevoflurane-induced preconditioning: evaluation of two different protocols in humans undergoing coronary artery bypass grafting (CABG)

Anesthesiology

Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery

Can J Anaesth

Original article
Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials