Effects of anesthetics on microvascular reactivity measured by vascular occlusion tests during off-pump coronary artery
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ORIGINAL RESEARCH
Effects of anesthetics on microvascular reactivity measured by vascular occlusion tests during off‑pump coronary artery bypass surgery: a randomized controlled trial Youn Joung Cho1 · Sol Ji Yoo1 · Karam Nam1 · Jin Young Bae1 · Seo Hee Lee1 · Yunseok Jeon1 Received: 3 May 2020 / Accepted: 27 August 2020 © Springer Nature B.V. 2020
Abstract Microvascular function may be modulated by various anesthetics. Desflurane and propofol anesthesia have different effects on microvascular function. However, there are few reports on the effects of sevoflurane and desflurane on microvascular function during cardiac surgery. We compared the effects of sevoflurane and desflurane on microvascular reactivity, as measured by the vascular occlusion tests (VOTs) during off-pump coronary artery bypass (OPCAB) surgery. Patients undergoing OPCAB were eligible for study inclusion. Patients were excluded if they were unsuitable for treatment with volatile agents or the VOT, had renal failure or uncontrolled diabetes, or were pregnant. The enrolled patients were randomized to receive sevoflurane or desflurane during surgery. Tissue oxygen saturation (StO2) dynamics during the VOT were measured at baseline (pre-anesthesia), pre-anastomosis, post-anastomosis of vessel grafts, and at the end of surgery. Macrohemodynamic variables, arterial blood gas parameters, and in-hospital adverse events were also evaluated. A total of 64 patients (32 in each group) were analyzed. StO2 dynamics did not differ between the groups. Compared to baseline, StO2 and the rate of recovery following vascular occlusion decreased at the end of surgery in both groups (adjusted p-value, 20 years) undergoing OPCAB surgery at Seoul National University Hospital were eligible for the study. Patients were excluded if they were unsuitable for volatile anesthetics (i.e., inherited disorders of skeletal muscle that may have risk of malignant hyperthermia), could not undergo the VOT of the upper extremities, had preoperative renal failure, uncontrolled diabetes, or peripheral vascular disease, refused to participate, or were pregnant (Fig. 1). After providing consent, the patients were randomly allocated to the sevoflurane and desflurane groups on the day of surgery. Block randomization (blocks of 4 or 6) was conducted by an independent research nurse using a computergenerated program, with patients allocated according to a
Journal of Clinical Monitoring and Computing
1:1 ratio. Using opaque envelopes, patients, surgeons, and investigators involved in data analysis were blinded to the group assignments.
2.3 Study protocol Without premedication, patients were monitored using 5-lead electrocardiography, non-invasive blood pressure (BP) and pulse oximetry measurements, the bispectral index, and cerebral oximetry (INVOS 5100C, cerebral/ somatic oximeter monitor, Medtronic, Minneapolis, MN). Before induction of anesthesia, radial artery cannulation was performed to continuously monitor BP under 1% lidocaine local anesthesia. General anesthesia was induce
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