IMPACT ОГ DESFLURANE AND SEVOELURANE OH THE HEMODYHAMIC PROEILE IH THE PATIEHTS WITH DIRECT MYOCARDIAL REVASCULIZATION UHDER CARDIO-PULMОNARY BYPASS

Inhalation anesthetics of desflurane and sevoflurane when used in aortocoronary bypass with cardio-pulmonary bypass can reduce the frequency of post-perfusion heart weakness t h rough supporting stable hemodynamic profile of the patients undergoing cardiac surgery. 11 owever the choice between these two medications is often disputable. 43 patients with coronary disease who underwent direct myocardial revasculization with artificial cardio-pulmonary bypass were examined. Desflurane was used as a general anesthetic for 28 patients: sevoflurane was used for 15 patients. During surgery expanded hemodynamic profile data of all patients were evaluated (cardiac index - Cl. stroke volume index - SVI. medium blood pressure - МНР. index of general peripheral resistance - IGPR, index of systolic operation of the left anti right ventricles, pulmonary artery wedge pressure, index of pulmonary resistance) as well as oxygen transporting blood function (delivery, consumption and oxygen extraction co-efficient. oxygen arteriovenous difference) and arterial blood lactate level. The investigated data were recorded before artificial cardio-pulmonary bypass, after reperfusion of myocardium and upon anesthesia completion. Results. Both groups did not have any confident differences in МНР. pulmonary artery pressure, heart rate. In all examined patients С I increased significantly compared to pre-perfusion period due to the increase of stroke volume and systolic discharge of the heart ventricles. And sevoflurane caused more persistent reduction of IGPR after artificial cardio-pulmonary bypass compared to desflurane which required using angiotonic support in 41.1% of patients versus 3.4% of patients in the group where desflurane was used (²criterion with credibility correction, p< 0.01). The bigger need in oxygen when sevoflurane was used during the surgery (p < 0.01) was accompanied by the bigger activation of anaerobic metabolism with increase of lactate concentration in post-perfusion period (p < 0.01) which can be explained by less depression of the global metabolism by sevoflurane compared to desflurane.

1. Барбараш Л. С., Ларионов М. В., Головкин А. С. и др. Биохимические и гемодинамические параметры коронарного кровотока как обоснование выбора анестетиков при операции коронарного шунтирования//Патол. кровообр. и кардиохирургия. -2011. -№ 2. -С. 64-68.

2. Ландони Дж., Лихванцев В. В., Фоминский Е. и др. Пути снижения летальности в периоперационном периоде при кардиохирургических операциях//Вестн. анестезиол. и реаниматол. -2015. -№ 2. -С. 33-38.

3. Лихванцев В. В., Гребенчиков О. А., Шмелева Е. А. и др. Анестетическое прекондиционирование: почему данные, полученные в эксперименте, не всегда подтверждаются в клинике?//Вестн. анестезиол. и реаниматол. -2013. -№ 4. -С. 9-15.

4. Ломиворотов В. В., Князькова Л. Г., Ломиворотова Л. В. и др. Прекондиционирующий эффект севофлурана у больных ишемической болезнью сердца, оперированных в условиях искусственного кровообращения//Патол. кровообр. и кардиохирургия. -2011. -№ 2. -С. 55-58.

5. Bein B., Renner J., Caliebe D. et al. Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery//Anesth. Analg. -2005. -Vol. 100, № 3. -Р. 610.

6. Bignami E., Landoni G., Fochi O. et al. Volatile anesthetics reduce mortality in cardiac surgery: a meta regression on 34,310 italian patients//SMART. Milan, Italy. -2008.

7. Bignami E., Landoni G., Gerli C. et al. Sevoflurane vs. propofol in patients with coronary disease undergoing mitral surgery: a randomised study//Acta Anaesthesiol. Scand. -2012. -Vol. 56, № 4. -Р. 482-490.

8. Blaudszun G., Morel D. R. Superiority of desflurane over sevoflurane and isoflurane in the presence of pressure-overload right ventricle hypertrophy in rats//Anesthesiology. -2012. -Vol. 117, № 5. -Р. 1051-1061.

9. Bolliger D., Seeberger M. D., Kasper J. et al. Different effects of sevoflurane, desflurane, and isoflurane on early and late left ventricular diastolic function in young healthy adults//Br. J. Anaesth. -2010. -Vol. 104, № 5. -Р. 547-554.

10. Cavaliere F., Gennari A., Martinelli L. et al. The relationship between systemic oxygen uptake and delivery during moderate hypothermic cardiopulmonary bypass: critical values and effects of vasodilatation by hydralazine // Perfusion. - 1995. - Vol. 10, № 5. - Р. 315-321. de Hert S. G., Cromheecke S. et al. Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients // Anesthesiology. - 2003. - Vol. 99. - Р. 314-323.

11. de Hert S. G., ten Broecke P. W. Mertens E. et al. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients//Anesthesiology. -2002. -Vol. 97. -P. 42-49.

12. Ebert T. J., Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane//Anesthesiology. -1993. -Vol. 79, № 3. -Р. 444-453.

13. Ebert T. J., Harkin C. P., Muzi M. Cardiovascular responses to sevoflurane: a review//Anesth. Analg. -1995. -Vol. 81, 6 Suppl. -Р. S11-S22.

14. Guarracino F., Landoni G., Tritapepe L., Pompei F. et al. Myocardial damage prevented by volatile anesthetics: a multicenter randomized controlled study//J. Cardiothorac. Vasc. Anesth. -2006. -Vol. 20, № 4. -Р. 477-483.

15. Hemmerling T. M., Minardi C., Zaouter C. et al. Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: a pilot study//Ann. Card. Anaesth. -2010. -Vol. 13, № 2. -Р. 116-122.

16. Jakobsen C. J., Berg H., Hindsholm K. B. et al. The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures//J. Cardiothorac. Vasc. Anesth. -2007. -Vol. 21, № 5. -Р. 664-671.

17. Komatsu T., Shibutani K., Okamoto K. et al. Critical level of oxygen delivery after cardiopulmonary bypass//Crit. Care Med. -1987. -Vol. 15, № 3. -Р. 194-197.

18. Kunst G., Klein A.A. Peri-operative anesthetic myocardial preconditioning and protection: cellular mechanisms and clinical relevance in cardiac anesthesia//Anaesthesia. -2015. -Vol. 70, № 4. -Р. 467-482.

19. Landoni G., Calabrò M. G., Marchetti C. et al. Desflurane versus propofol in patients undergoing mitral valve surgery//J. Cardiothorac. Vasc. Anesth. -2007. -Vol. 21, № 5. -Р. 672-677.

20. Lin E., Symons J. A. Volatile anesthetic myocardial protection: a review of the current literature//HSR Proceedings in intensive care and cardiovascular anesthesia. -2010. -Vol. 2. -Р. 105-109.

21. Özarslan N. G., Ayhan B., Kanbak M. et al. Comparison of the effects of sevoflurane, isoflurane, and desflurane on microcirculation in coronary artery bypass graft surgery//J. Cardiothorac. Vasc. Anesth. -2012. -Vol. 26, № 5. -Р. 791-798.

22. Preckel B., Müllenheim J., Hoff J. et al. Haemodynamic changes during halothane, sevoflurane and desflurane anaesthesia in dogs before and after the induction of severe heart failure//Eur. J. Anaesthesiol. -2004. -Vol. 21, № 10. -Р. 797-806.

23. Sarkar S., GuhaBiswas R., Rupert E. Echocardiographic evaluation and comparison of the effects of isoflurane, sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction//Ann. Card. Anaesth. -2010. -Vol. 13, № 2. -Р. 130-137.

24. Sivanna U., Joshi S., Babu B. et al. A comparative study of pharmacological myocardial protection between sevoflurane and desflurane at anesthetic doses in patients undergoing off pump coronary artery bypass grafting surgery//Indian. J. Anaesth. -2015. -Vol. 59, № 5. -Р. 282-286.

25. Swyers T., Redford D., Larson D. F. Volatile anesthetic-induced preconditioning//Perfusion. -2014. -Vol. 29, № 1. -Р. 10-15.

26. Turkilmaz S., Baltaci B., Ceyhan A. et al. Comparison of the hemodynamic effects of sevoflurane and desflurane using a thoracic electrical bioimpedance monitor//Gazi Med. J. -2004. -Vol. 15. -Р. 45-51.

27. Yamanaka H., Hayashi Y. Myocardial preconditioning in anesthesia: from bench to bedside//Masui. -2009. -Vol. 58, № 3. -Р. 279-287.

28. Yu C. H., Beattie W. S. The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis//Can. J. Anaesth. -2006. -Vol. 53, № 9. -Р. 906-918.