Effect of sevoflurane during inhalation anesthesia on myocardial ischemia reperfusion injury

Objective To evaluate the effect of sevoflurane during inhalation anesthesia on myocardial ischemia reperfusion injury. Methods Ninety patients with rheumatic heart disease who received mitral valve replacement were divided into propofol group,propofol + sevoflurane group and sevoflurane group,with 30 patients in each group,the American society of anesthesiologists and heart function grade of all the patients were Ⅱ- Ⅲ. Patients in propofol group were given target controlled infusion of propofol 1. 5- 2. 0 mg·L- 1during the whole course. Patients in propofol + sevoflurane group were given target controlled infusion of propofol 0. 5- 1. 0 mg·L- 1,and were given inhalation of sevoflurane 0.5 minimum alveolar concentration(MAC) supplemented. Patients in sevoflurane group were given sevoflurane during inhalation anesthesia 1.0-1.5 MAC,and were given artificial membrane lung inhalation anesthesia during cardiopulmonary bypass. The heart rate( HR),mean arterial pressure(MAP) and central venous pressure(CVP) of patients in three groups before operation( T0),before cardiopulmonary bypass(T1),after cardiopulmonary bypass(T2) and after operation(T3) were recorded and compared. The level of cardiac troponin I(cTnI) and malondialdehyde( MDA),the activities of creatine phosphokinase isoenzyme( CK-MB),superoxide dismutase(SOD) in the three groups before anesthesia induction(t0),two hours(t1),six hours(t2),twenty-four hours(t3) and forty-eight hours(t4) after aortic opening were detected. Postoperative situation of all patients were compared. Results Of all the patients,there was no significant difference in hemodynamics during operation. The level of cTnIand CK-MB activity of t1 to t4were higher than t0significantly(P 0. 05),SOD activity of t1 to t3was lower than that of t0 and t4significantly(P 0. 05),the MDA level was higher than that of t0 and t4significantly(P 0. 05). As for the comparison between groups,the concentration of cTnI of sevoflurane group was lower than propofol group and propofol + sevoflurane group significantly at t1 to t4(P 0. 05),CK-MB activity of sevoflurane group was lower than propofol group and propofol + sevoflurane group significantly at t2 to t4(P 0.05),SOD activity of sevoflurane group was higher than propofol group and propofol +sevoflurane group significantly(P 0.05),MDA level was lower than propofol group and propofol +sevoflurane group significantly at t1 to t3(P 0.05). The cardiac autonomic rebeating rate of sevoflurane group was higher than those of propofol group and propofol + sevoflurane group significantly(P 0. 05),while tracheal extubation time,myocardial contractility score,adverse cardiovascular events and the duration of hospitalization in intensive care unit were lower than propofol group and propofol + sevoflurane group significantly(P 0.05). Conclusion Sevoflurane during inhalation anesthesia can reduce the myocardial ischemia reperfusion injury in mitral valve replacement,and it can protect the myocardial.