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BJA Advance Access originally published online on October 3, 2007
British Journal of Anaesthesia 2007 99(5):624-631; doi:10.1093/bja/aem264
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sevoflurane preconditioning at 1 MAC only provides limited protection in patients undergoing coronary artery bypass surgery: a randomized bi-centre trial{dagger},{ddagger}

V. Piriou1,*, J. Mantz2, G. Goldfarb3, M. Kitakaze4, P. Chiari5, S. Paquin6, C. Cornu7, J.-B. Lecharny6, P. Aussage8, E. Vicaut3, A. Pons3 and J.-J. Lehot5

1 EA 1896, Service d’Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, 69495 Pierre Bénite Cedex, France
2 Département d’Anesthésie Réanimation, Hôpital Beaujon, 100 Bd du Général Leclerc, 92110 Clichy, France
3 Département Médical Abbott France, 10 rue d’Arcueil, BP 90233, F-94528 Rungis Cedex, France
4 Cardiovascular Division of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
5 EA 1896, Service d’Anesthésie Réanimation, Hôpital Cardio-Vasculaire et Pneumologique Louis Pradel, B16–28 avenue Doyen Lépine, F-69500 Lyon Bron, France
6 Département d’Anesthésie Réanimation, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
7 Inserm CIC201, CHU Lyon, Service de Pharmacologie Clinique, Lyon F-69000, France
8 Biostatistics, MDS Pharma Services France SAS, 6, avenue de la Cristallerie, 92316 Sèvres, France

* Corresponding author. E-mail: piriou{at}univ-lyon1.fr

Background: Volatile agents can mimic ischaemic preconditioning leading to a decrease in myocardial infarct size. The present study investigated if a 15 min sevoflurane administration before cardiopulmonary bypass (CPB) has a cardioprotective effect in patients undergoing coronary surgery.

Methods: Seventy-two patients were randomized in two centres. The intervention group (S) received 1 MAC sevoflurane administrated via the ventilator for 15 min followed by a 15 min washout before CPB, the control group did not. The primary outcome was the postoperative troponin Ic peak. A biopsy of the atrium was taken during canulation for enzyme dosages. Results are expressed as mean (SD).

Results: Neither troponin Ic nor tissular enzyme measurement exhibited any difference between the groups: peak of troponin Ic was 4.4 (5.6) in S group vs 5.2 (6.6) ng ml–1 in control group (ns). Intratissular ecto-5'-nucleotidase activity was 7.1 (4.3) vs 8.5 (11.9), protein kinase C activity was 27.1 (15.7) vs 29.2 (28.7), tyrosine kinase activity was 101 (54.1) vs 98.5 (63.3), and P38 MAPKinase activity was 131.1 (76.1) vs 127.1 (86.8) nmol mg protein–1 min–1 in S group and control group, respectively (ns). However there were fewer patients with low postoperative cardiac index in S group (11% in S vs 35% in control group, P < 0.05) when considering the per protocol population. In S group, 25% of patients required an inotropic support during the postoperative period, vs 36% of patients in control group (ns).

Conclusions: This study did not show a significant preconditioning signal after 15 min of sevoflurane administration. The 15 min duration might be too short or the concentration of sevoflurane too low to induce cardioprotection detected by troponin I levels.

Keywords: anaesthesia, cardiovascular; anaesthetics volatile; heart, ischaemia

{dagger} This work has been presented as an abstract during the annual meeting of the European Society of Anesthesiology (Euroanaesthesia 2006 Madrid, Spain, June 3–6, 2006). In: Eur J Anaesthesiol 2006; 23 (Suppl. 37): A248.

{ddagger} This article is accompanied by Editorial I.


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E-letters:

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sevoflurane and cardioprotection
luca siracusano, et al.
British Journal of Anaesthesia, 26 Oct 2007 [Full text]
reply to luca siracusano, viviana girasole (26 October 2007)
PIRIOU Vincent, et al.
British Journal of Anaesthesia, 20 Nov 2007 [Full text]

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