TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and Cognitive Outcomes

Area of Science:

• Anesthesiology
• Cardiac Surgery
• Neuroscience

Background:

• Coronary artery bypass grafting (CABG) surgery can elicit significant perioperative inflammatory responses.
• Anesthetic techniques may influence both systemic inflammation and early neurocognitive function following major cardiac surgery.

Purpose of the Study:

• To compare the perioperative inflammatory markers and early neurocognitive outcomes in adult patients undergoing elective CABG using total intravenous anesthesia (TIVA) versus volatile anesthesia.
• To evaluate the impact of anesthetic choice on postoperative recovery metrics.

Main Methods:

• Prospective, randomized controlled trial conducted at a tertiary care academic medical center.
• Fifty adult patients (18-65 years) undergoing elective on-pump CABG were randomized to propofol-based TIVA or sevoflurane-based volatile anesthesia.
• Serum interleukin-6 (IL-6) levels, Mini-Mental State Examination (MMSE) scores, ventilation duration, vasoactive-inotropic score (VIS), renal function, and ICU stay were assessed.

Main Results:

• Both TIVA and volatile anesthesia groups showed similar increases and subsequent decreases in IL-6 levels at 24 and 48 hours postoperatively, with no significant intergroup differences.
• Patients in the TIVA group demonstrated significantly higher MMSE scores at 24 and 48 hours postoperatively.
• The TIVA group experienced a shorter duration of mechanical ventilation compared to the volatile anesthesia group.

Conclusions:

• TIVA and volatile anesthesia produce comparable perioperative inflammatory responses (IL-6 levels) in CABG patients.
• TIVA is associated with superior early postoperative cognitive function and expedited emergence from mechanical ventilation.
• These findings suggest a potential neurocognitive advantage of utilizing TIVA in patients undergoing CABG surgery.