Effect of sevoflurane combination with epidural anesthesia on myocardial injury in patients with coronary artery disease undergoing non-cardiac surgery.

OBJECTIVES: To determine the effect of sevoflurane combination with epidural anesthesia on myocardial injury in patients with coronary artery disease (CAD) undergoing non-cardiac surgery.

METHODS: The investigation was performed in TianJin NanKai Hospital, TianJin, China from November 2009 to March 2010. Eighty patients with CAD undergoing elective abdominal surgery were randomized into 4 groups: group S1- combined sevoflurane general and epidural anesthesia; group S2 - standard sevoflurane general anesthesia; group P1 - combined propofol general and epidural anesthesia; and group P2 - standard propofol general anesthesia. Mean arterial pressure, central venous pressure, electrocardiogram, and bispectral index was monitored throughout the surgery. The serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha TNF-alpha, cardiac troponin I (cTnI), and glycogen phosphorylase BB (GP-BB) was measured at different time points during surgery.

RESULTS: The ST depression in group P1 and S2 was significantly higher than that in group S1 (p=0.000) and lower than that in group P2 (p=0.00). The serum levels of IL-6, IL-8, TNF-alpha, cTnI, and GP-BB in group P1 and S2 were dramatically greater than that in group S1 (p=0.00), and lower than that in group P2 (p=0.00).

CONCLUSIONS: Sevoflurane in combination with continuous epidural anesthesia could protect against myocardial damage in patients with CAD, downregulation of IL-6, IL-8, and TNF-alpha might contribute to this protection.