A prospective, randomised, single‐blind pilot study to determine the effect of anaesthetic technique on troponin T release after off‐pump coronary artery surgery

Ischaemic damage to the myocardium inevitably occurs during coronary artery surgery. However, the extent of the damage may be influenced by the anaesthetic technique used. The most sensitive and reliable marker of myocardial damage is currently thought to be troponin T. We conducted a prospective, randomised, single‐blind pilot study to determine the baseline values of troponin T release after off‐pump coronary artery bypass surgery in 30 patients randomly allocated to receive either propofol, isoflurane or isoflurane and high thoracic epidural analgesia. All other treatment was standardised. Patients undergoing emergency surgery and those with unstable angina were excluded. Blood samples were taken at 0, 3, 6, 12, 24 and 48 h after surgery for troponin T analysis. Mean troponin T levels at 24 h were not significantly different between the groups (p = 0.41). These data allows appropriate power calculations for further, large‐scale studies to determine the anaesthetic technique that provides optimal myocardial protection.

[1]  N. Agnew,et al.  Isoflurane and coronary heart disease. , 2002, Anaesthesia.

[2]  C. O'Connor,et al.  Epidural anesthesia and analgesia for coronary artery bypass graft surgery: still forbidden territory? , 2001, Anesthesia and analgesia.

[3]  G. Stone,et al.  Long-term clinical events following creatine kinase--myocardial band isoenzyme elevation after successful coronary stenting. , 2000, Journal of the American College of Cardiology.

[4]  N. Nader,et al.  Blood product use in cardiac revascularization: comparison of on- and off-pump techniques. , 1999, The Annals of thoracic surgery.

[5]  A. Bochenek,et al.  Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and off-pump beating heart. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  J. Pepper,et al.  Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass , 1999, Heart.

[7]  H. Scheld,et al.  High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. , 1999, Anesthesia and analgesia.

[8]  H. Katus,et al.  Biochemical markers in the diagnosis of coronary artery disease. , 1998, European heart journal.

[9]  P O Collinson,et al.  Troponin T or troponin I or CK-MB (or none?). , 1998, European heart journal.

[10]  J. O'Donnell,et al.  Cardiac Troponins in Patients with Renal Dysfunction , 1998, Annals of clinical biochemistry.

[11]  Y. Abiko,et al.  Propofol Improves Functional and Metabolic Recovery in Ischemic Reperfused Isolated Rat Hearts , 1998, Anesthesia and analgesia.

[12]  P. Pagel,et al.  Isoflurane Mimics Ischemic Preconditioning via Activation of KATP Channels: Reduction of Myocardial Infarct Size with An Acute Memory Phase , 1997, Anesthesiology.

[13]  P. Pagel,et al.  Glyburide, a KATP Channel Antagonist, Attenuates the Cardioprotective Effects of Isoflurane in Stunned Myocardium , 1996, Anesthesia and analgesia.

[14]  S. Gisvold,et al.  Thoracic epidural analgesia in aortocoronary bypass surgery I: haemodynamic effects , 1994, Acta anaesthesiologica Scandinavica.

[15]  Z. Bosnjak,et al.  The effects of halothane, enflurane, and isoflurane on calcium current in isolated canine ventricular cells. , 1991, Anesthesiology.

[16]  A. Keats,et al.  Incidence of perioperative myocardial ischemia detected by different electrocardiographic systems. , 1990, Anesthesiology.

[17]  Nirav C Patel,et al.  Does off-pump total arterial revascularization without aortic manipulation influence neurological outcome? A study of 226 consecutive, unselected cases. , 2002, The heart surgery forum.

[18]  S. Chung,et al.  Intracoronary propofol attenuates myocardial but not coronary endothelial dysfunction after brief ischaemia and reperfusion in dogs. , 1999, British journal of anaesthesia.