Randomized Comparison of Sevoflurane vs. Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery
Background—Volatile anesthetics provide myocardial preconditioning in coronary surgery patients. We hypothesized that sevoflurane compared to propofol reduces the incidence of myocardial ischemia in patients undergoing major noncardiac surgery.
Methods and Results—We enrolled 385 patients at cardiovascular risk in 3 centers. Patients were randomized to maintenance of anesthesia with sevoflurane or propofol. We recorded continuous ECG (cECG) for 48 hours perioperatively, measured troponin T and NT-proBNP on postoperative days (POD) 1 and 2, and evaluated postoperative delirium by the Confusion Assessment Method. At 6 and 12 months, we contacted patients by phone to assess major adverse cardiac events (MACE). The primary endpoint was a composite of myocardial ischemia detected by cECG and/or troponin elevation. Additional endpoints were postoperative NT-proBNP concentrations, MACE, and delirium. Patients and outcome assessors were blinded. We tested dichotomous endpoints by chi-squared and NT-proBNP by Mann-Whitney test on an intention-to-treat basis. Myocardial ischemia occurred in 75 patients (40.8%) in the sevoflurane and 81 (40.3%) in the propofol group (relative risk [RR], 1.01; 95% confidence interval [CI], 0.78-1.30). NT-proBNP release did not differ across allocation on POD 1 or 2. Within 12 months, 14 patients (7.6%) suffered a MACE after sevoflurane and 17 (8.5%) after propofol (RR, 0.90; 95% CI, 0.43-1.87). The incidence of delirium did not differ (11.4% vs. 14.4%, P=0.760)
Conclusions—Compared to propofol, sevoflurane did not reduce the incidence of myocardial ischemia in high-risk patients undergoing major noncardiac surgery. The sevoflurane and propofol groups did not differ in postoperative NT-proBNP release, MACE at 1 year, or delirium.
Clinical Trial Registration Information—http://www.clinicaltrials.gov/; Identifier: NCT00286585
- Received June 22, 2012.
- Accepted October 5, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited