[PHARMACOLOGICAL POSTCONDITIONING BY SEVOFLURANE DURING CARDIAC SURGERY.]

Area of Science:

• Cardiology
• Anesthesiology
• Cardiac Surgery

Background:

• Myocardial protection is crucial during cardiac surgery, especially with prolonged anoxia.
• Sevoflurane postconditioning is explored to optimize protection against ischemia-reperfusion injury.

Purpose of the Study:

• To establish an optimal sevoflurane postconditioning protocol for infarction patients undergoing cardiac surgery.
• To evaluate the efficacy of sevoflurane in mitigating myocardial damage during prolonged anoxia.

Main Methods:

• A comparative study involving two groups: control (CON100) and sevoflurane postconditioning (SEV100).
• Sevoflurane (2.0 vol. %) was administered during extracorporeal circulation before aortic clamp removal and during early reperfusion in the SEV100 group.
• Clinical and laboratory parameters including troponin T, lactate, glucose, inflammatory cytokines (IL-6, IL-8, TNF-alpha), central hemodynamics, and echocardiography were assessed.

Main Results:

• While anaerobic metabolism markers showed no significant difference, SEV100 group exhibited significantly lower levels of proinflammatory cytokines, indicating better reperfusion.
• Instrumental examination revealed that sevoflurane postconditioning led to significantly reduced ischemia-reperfusion injury.
• The SEV100 group showed improved heart rate recovery (93% vs. 81%), lower incidence of perioperative myocardial ischemia (5.8% vs. 12.5%), and fewer reperfusion arrhythmias (8.8% vs. 21.8%).

Conclusions:

• Sevoflurane postconditioning, combined with FPC, offers superior resistance to myocardial ischemia-reperfusion injury in patients with prolonged infarction (>100 minutes) compared to cardioplegic solution alone.
• This sevoflurane-based method is recommended as an adjunct for myocardial protection against ischemia-reperfusion injury.