Myocardial protection with Sevoflurane in Coronary Artery Bypass Grafting Surgery

Abstract

Sevoflurane is a widely used volatile anesthetic agent, but the simple efficacy of sevoflurane in cardio protection is unknown. This systematic review assesses the effect of sevoflurane in myocardial protection during coronary artery bypass graft surgery. An electronic search was undertaken, without language restriction, from MEDLINE, EMBASE, and CENTRAL. All relevant randomized controlled trials of adult cardiac patients undergoing coronary artery bypass grafting surgery which involved in sevoflurane were included. Exclusion criteria were duplicate publications and lack of outcome data. The outcome measures were cardiac troponinI serum concentration, myocardial infarction, and death. Statistical heterogeneity and inconsistency of each outcome were detected. Publication bias was measured through visual inspection of funnel plots of the outcomes.Twenty eligible randomized clinical trials were identified, with 1,912 patients. Thirteen studies, with 759 patients, reported 8a significant reduction in cardiac troponin Iserum concentration (P < 0.0001). There was no significant difference between sevoflurane and control with respect to myocardial infarction (P = 0.23, 14 studies, 1,395 patients) and mortality (P = 0.36, 15 trials, 1,465 patients). This study has shown the evidence of sevoflurane protection in coronary artery bypass graft surgery, with a down regulation in troponin I.