A COMPARATIVE STUDY OF HEMODYNAMICS AND CARDIOPROTECTIVE EFFECTS OF SEVOFLURANE & ISOFLURANE IN PATIENTS UNDERGOING OFF PUMP CORONARY ARTERY BYPASS GRAFTING

Dr Sushila Meena; Dr Indu Verma; Dr C.K Vyas; Dr Reema Meena

Volume : VI, Issue : VII, July - 2017

A COMPARATIVE STUDY OF HEMODYNAMICS AND CARDIOPROTECTIVE EFFECTS OF SEVOFLURANE & ISOFLURANE IN PATIENTS UNDERGOING OFF PUMP CORONARY ARTERY BYPASS GRAFTING

Dr Sushila Meena, Dr Indu Verma, Dr C. K Vyas, Dr Reema Meena

Abstract :

Background:

Off pump coronary artery bypass grafting (CABG) avoids the post–operative complications which are related to on pump CABG. But off pump CABG is also associated with hemodynamic instability. Sevoflurane and Isoflurane in addition to Fentanyl & neuromuscular blocking agents are considered safe during off pump CABG. They have been reported to exert myocardial protective effects by decreasing the concentration of cardiac enyzymes & improving the heart functions.

Methods :

Fifty patients with Left ventricular EF>40% were given sevoflurane (gp A n=25) or isoflurane (gp B n=25) after induction with etomidate, fenanyl, midazolam & rocuronium in patients undergoing off pump CABG. Hemodynamics were assessed with Edwards Flo Trac continuous cardiac output monitor. Statistical analysis was done by using student t test and paired t test. A p value of less than 0.05 was considered statistically significant and p value > 0.05 was not significant.

Results:

Both agents showed favourable intra–operative hemodynamics. There was a tendency to decrease in B.P & H.R with each volatile agent but comparatively hemodynamics were more stable in the sevoflurane group. However these findings were not statistically significant. Time taken for eye opening & verbal command was significantly earlier in sevoflurane group (3.37 � 0.95 hr) as compared to isoflurane group (3.99 � 0.98 hr) with a p value =0.027. Extubation was also earlier in the sevoflurane group (7.54 �1.58 hr) as compared to isoflurane group (8.56�1.99 hr) with a p value =0.049.

Conclusion:

Sevoflurane provided a better hemodynamic profile in terms of Heart rate, Blood pressure, cardiac index and enzymes levels even though the difference was not found to be statistically significant. Also sevoflurane provided early awakening & extubation which was statistically significant as compared to isoflurane.