Özcan Erdemli

A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG

The aim of this prospective, randomized, and double-blinded study was to compare the effects of desflurane, sevoflurane, propofol on both atrial and ventricular wall function by measurement of QT dispersion (QTd), corrected QT dispersion (QTcd), and P dispersion (Pd) on electrocardiogram (ECG). Forty-six patients from the American Society of Anesthesiologists class I-II undergoing noncardiac surgery, were enrolled in this study. Patients were randomly allocated to receive desflurane, sevoflurane or propofol anesthesia. ECG recordings were taken before and after 5 minutes of drug administration. Induction with desflurane significantly increased the QTd compared to baseline (38 +/- 2 ms vs. 62 +/- 6 ms, P 0.05). Sevoflurane and propofol anesthesia was not associated with any changes in QTd. QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but this decrease was only significant in the propofol group (67 +/- 5 ms vs. 45 +/- 3 ms, P 0.05). Pd was significantly increased after induction with desflurane (34 +/- 3 vs. 63 +/- 6 ms, P 0.05). There was a significant increase in QTd and Pd in desflurane group, but this increment did not cause any dangerous arrhythmias. QTcd significantly decreased in propofol group. We believe that further investigations are required for using desflurane as safe as sevoflurane and propofol in noncardiac surgery patients who have high cardiac arrhythmia and ischemia risk.

Middle Cerebral Arterial Blood Flow Velocity and Hemodynamics in Heart Surgery

The aim of this study was to evaluate the effects of propofol, isoflurane, and sevoflurane on middle cerebral arterial blood flow velocity during open heart surgery, and the relationship between these effects and hemodynamic parameters. Fifty-two patients undergoing coronary artery bypass on cardiopulmonary bypass were divided randomly into 3 groups: the first group received 100 μg·kg−1·min−1 propofol, the other groups received one minimum alveolar concentration of sevoflurane or isoflurane for anesthesia maintenance. Middle cerebral arterial blood flow velocities were measured by transcranial Doppler, and hemodynamics were measured by the thermodilution technique. Middle cerebral arterial blood flow velocities decreased significantly after administration of isoflurane and propofol, but there was no significant difference between the groups. After weaning from cardiopulmonary bypass, cerebral blood flow increased and came close to the value after induction in all groups. The pulsatility index and resistivity index increased significantly only after the propofol infusion, but there was no significant difference between the groups.

Short time antioxidant effect of sevoflurane and desflurane anesthesia, immediately before coronary artery bypass grafting

Abstract Aim. Volatile anesthetics may represent a choice to attenuate oxidant effects. The aim of this study is to investigate the antioxidant status during sevoflurane and desflurane anesthesia immediately before coronary artery bypass graft surgery (CABG) with malondialdehyde (MDA), superoxide dismutase (SOD) and gluthation peroxidase (GPx). Methods. Forty patients, undergoing coronary artery bypass surgery, were enrolled in the study and randomized into two groups of 20 patients each. Anesthesia was maintained with 40% oxygen in air mixture, 1 minimum alveolar concentration (MAC) of desflurane in Group D and sevoflurane in Group S. Blood sampling for the measurements of MDA, SOD and GPx were performed at, T1-before anesthesia induction (baseline), T2-before surgical incision (about 20 min after T1), T3-before cardiopulmonary bypass (about 60 min after T2). Results. Plasma concentrations of MDA, SOD and GPx levels increased significantly during T2 and T3 periods as compared with the baseline values in both groups. This increase was greater in group D versus group S. Conclusion. We conclude that desflurane may cause more systemic lipid peroxidation than sevoflurane during immediately before CABG. Keywords: Cardiac anesthesia, desflurane, sevoflurane, oxidative stress, antioxidant effect Ozet Amac. Volatil anestezikler oksidan etkiyi zayiflatabilirler. Bu calismanin amaci koroner arter bypass greft ameliyatinin hemen oncesinde malondialdehit (MDA), superoksit dismutaz (SOD) ve glutatyon peroksidaz (GPx) ile sevofluran ve desfluranin antioksidan etkisinin arastirilmasidir. Yontemler. Koroner arter baypas greft ameliyati gecirecek 40 hasta calismaya alindi, hastalar rastgele 20’ser kisilik iki gruba ayrildi. Anestezi %40 oksijen ile hava karisimi yaninda Grup D’de 1MAC desfluran, Grup S’de 1MAC sevofluran ile surduruldu. MDA, SOD ve GPx icin kan ornekleri; T1; anestezi induksiyonundan once (bazal), T2; cerrahi insizyondan once (yaklasik T1den 20 dk sonra), T3; kardiyopulmoner baypastan once (yaklasik T2 den 60 dk sonra) alindi. Bulgular. Bazal degerlere gore her iki grupta MDA, SOD ve GPx degerleri T2 ve T3 zamanlarinda anlamli artis gosterdi. Grup D icin bu artis Grup S’den daha fazlaydi. Sonuc. Koroner arter baypas greft ameliyatinin hemen oncesinde desfluran, sevoflurandan daha fazla sistemik lipid peroksidasyonuna neden olur sonucuna vardik. Anahtar sozcukler: Kardiyak anestezi, desfluran, sevofluran, oxidatif stres, antioxidan etki