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Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels

L’anesthésie au propofol, comparé à l’isoflurane, n’a pus d’avantage pour la protection cérébrale pendant la circulation extracorporelle: une étude préliminaire des niveaux de protéines S-100ß

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Abstract

Purpose

Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100ß protein and neuropsychological tests after coronary artery bypass grafting (CABG).

Methods

Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group R Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100ß protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24th hr postoperatively (T5).

Results

Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P S-100ß protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05).

Conclusions

Despite reports about the neuroprotective effects of propofol, S-100ß protein levels were significantly elevated in group R Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.

Résumé

Objectif

Malgré les progrès de l’anesthésie, la circulation extracorporelle (CEC) et les techniques chirurgicales, les lésions cérébrales demeurent une importante source de morbidité postchirurgie cardiaque. Les effets neurologiques comparés de l’isoflurane et du propofol sont présentés par l’analyse des protéines sériques S-100ß et des test neuropsychologiques après un pontage aortocoronarien (PAC).

Méthode

Notre étude préliminaire, prospective et contrôlée a porté sur 20 patients, répartis au hasard en deux groupes, qui devaient subir un PAC. L’isoflurane a été utilisé dans le groupe I et le propofol dans le groupe P L’examen neurologique et une batterie de tests neuropsychologiques, comprenant le mini-examen de l’état mental (MMSET pour mini mental state examination) et le test visuel et auditif de mémoire des chiffres (VADST pour visual aural digit span test), ont été réalisés avant l’opération et aux jours trois et six postopératoires. Les échantillons sanguins nécessaires à l’analyse des protéines S-100ß ont été prélevés avant l’anesthésie (T1), après l’héparinisation (T2), 15 min après le début de la CEC (T3), après la CEC (T4) et 24 h après l’opération (T5).

Résultats

Les examens neurologiques postopératoires étaient normaux. La performance au VADST a décliné significativement au jour trois (P < 0,05) chez tous les patients. Il n’y a pas eu de différence intergroupe significative des scores de VADST et de MMSET. Dans le groupe P, les niveaux de protéines S-100ß ont augmenté à T3 et T4, comparés aux niveaux préopératoires et aux niveaux observés avec l’isoflurane (P < 0,05).

Conclusion

Malgré des études rapportant les effets neuroprotecteurs du propofol, les niveaux de protéines S-100ß ont été significativement élevés dans le groupe P de notre étude. Aucune détérioration neuropsychologiques n’a été observée, mais le propofol ne semble pas offrir d’avantage sur l’isoflurane pour la protection cérébrale pendant la CEC.

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Author information

Correspondence to Meral Kanbak.

Additional information

This study was supported by AB Sangtec Medical, Bromma-Sweden.

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Kanbak, M., Saricaoglu, F., Avci, A. et al. Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels. Can J Anesth 51, 712–717 (2004). https://doi.org/10.1007/BF03018431

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Keywords

  • Coronary Artery Bypass Grafting
  • Isoflurane
  • Mean Arterial Pressure
  • Cardiopulmonary Bypass
  • Mini Mental State Examination