[Comparison of sevoflurane and propofol anesthesia for aortocoronary bypass surgery without artificial circulation]

The purpose of the study was to compare the effectiveness of sevoflurane and propofol during combined anesthesia with epidural component during aortocoronary bypass surgery without artificial circulation.

The study included 24 patients with ischemic heart disease. All patients underwent aortocoronary bypass surgery on the working heart (from 1 to 5 bypasses) under combined anesthesia (propofol or sevoflurane with epidural anesthesia with the use of ropicavaine and fentanyl). Induction of anesthesia was carried out by midasolam 0.06 mg/kg, propofol 1-1.5 mg/kg, fentanyl 2.5 mcg/kg, myorelaxation was reached by pipecuronium bromide 0.1 mg/kg. Patients were randomized into propofol group (n = 12) and sevoflurane group (n = 12). Both groups received low flow anesthesia (1l/min) with the use of Drager Primus anesthesia workstation. Anesthesia in the first group was maintained by propofol 3-5 mg/kg/h, in the second group by sevoflurane 0.5-3 vol.%. In both groups additional fentanyl was administered in the dose of 1.2 -1.5 mcg/kg/h.

In the postoperative period the increase of the stroke volume and decrease of blood plasma lactate were noticed in the sevoflurane group. The postoperative pain, 6 hours after the aortocoronary bypass surgery in the control group was evidently higher according to Visual Analogue Scale.

Use of sevorane as a component of combined anesthesia during aortocoronary bypass surgery allows to improve the performance of the myocardium, reduce the severity of hypoperfusion in the perioperative period and reduce the severity of pain after the surgery compared to propofol anesthesia.