Table 2 Studies including anaesthetics agents

Mroziński et al. (2014) Anaesthesiol Intensive Ther, Poland [40] Prospective randomized open-label trial

Sixty OPCAB 28 Propofol 32 Desflurane

DES PP

Assessment of hemodynamic function and myocardial injury markers

DES group demonstrated improved stability, expressed as LVSWI; no differences in myocardial injury in between groups

No difference reported between DES and PP in major haemodynamic parameters, myocardial injury markers and the long-term outcome; DES might accelerate LVSWI recovery

Orriach et al. (2013) J Crit Care, Spain [25] Prospective randomized trial

Sixty OPCAB

SS and PP (intra-op and post op as postconditioning)

BNP Troponin release Need for inotropic drugs

SS group had reduced BNP, troponin release and number of inotropic drugs Compared to S-P and P-P groups

SS administration in OR and CICU, decreased troponin release compared with SS intra-op, but both were a better option to decrease troponin level when compared to PP

20

Sevoflurane/Sevoflurane (S-S)

20 Sevoflurane/Propofol (S-P) 20 Propofol/Propofol (P-P)

Wang et al. (2013) Scand Cardiovasc J, China [26] Prospective randomized controlled trial

Forty-eight OPCAB

SS

BNP

SS significantly decreased post-surgical troponin levels No significant differences in BNP level among groups

SS exerted significant myocardial protective effect; BNP could not predict myocardial protective effect of SS in OPCAB

20 Sevoflurane

Troponin release

20 Control

Suryaprakash et al. (2013) Ann Card Anaesth, India [28] Prospective randomized trial

One hundred thirty

SS

Troponin release

Changes in troponin levels at all time intervals were comparable in the three groups

No difference found in myocardial protection with SS or DES or PP

nine OPCAB

DES

48 Sevoflurane

PP

52 Desflurane

39 Propofol

Tempe et al. (2011) J Cardiothorac Vasc Anesth, India [38] Prospective randomized trial

Forty-five OPCAB

ISO

Troponin release

Troponin release in the PP group was significantly higher than the ISO group at 6 and 24 hours after surgery

ISO provided protection against myocardial damage by lowering levels of troponin-T

Isoflurane

PP

Propofol

Ballester et al. (2011) Eur J Anaesthesiol, Spain [33] Prospective controlled randomized trial

Thirty-eight OPCAB

SS

Markers of lipoperoxidation (F2-isoprostanes) and nitrosative stress (nitrates/nitrites) measured in coronary sinus blood

F2-isoprostanes concentrations were significant lower in the SS group at all different time point

SS showed better antioxidative properties than PP

20 Sevoflurane

PP

18 Propofol

Kim et al. (2011) Anaesth Intensive Care, Korea [29] Prospective randomized controlled trial

Ninety-four OPCAB

SS

CK MB and troponin release

No statistically differences in between groups in terms of CK-MB and troponin release at different end points

SS and PP had similar CK-MB and troponin values

47 Sevoflurane

PP

47 Propofol

(both in a remifentanil based anesthesia)

Hammerling et al. (2010) Ann Card Anaesth Canada [34] Prospective double blinded trial

Forty OPCAB

SS

Incidence of arrhythmias

Supraventricular tachycardia occurred only in the DES-group, AF was significantly more frequent in the DES group versus SEVO-group

SS found to be more advantageous than DES, as it was associated with less AF or supraventricular arrhythmias

20 Sevoflurane

DES

20 Desflurane

Xu (2009) J South Med Univ, China [42] Prospective controlled randomized trial

Twenty four OPCAB

REMI

Troponin release

Statistically significant reduction of troponin level in the REMI group

Troponin levels of REMI preconditioning group were markedly decreased after the operation in comparison with those of the control group

12 Remifentanil

12 Control

Drenger et al. (2008) Journal of Cardiothoracic and Vascular Anesthesia, Israel [21] Prospective controlled randomized trial

Twenty five OPCAB

IP induced with single 5 min LAD occlusion followed by 5 min reperfusion 1.6% ENF started 15 min before LAD occlusion

Myocardial metabolism

Lactate production in the ENF group decreased significantly compared with control and IP groups. Oxygen utilization in the control group was 44% higher than the other two groups Early recovery of anterior wall hypokinesis in both study groups

Application of methods such as IP or volatile anesthesia appeared to reduce the metabolic deficit

8 Control

9 IP

8 Enflurane

Hemmerling (2008) European Journal of Anaesthesiology, Canada [31] Prospective randomised trial

Fourty OPCAB

SS

Troponin/CK-MB

No differences in terms of enzymes release, heart contractility and haemodynamic values Extubation time was significantly shorter with SS compared to ISO

SS and ISO provided the same ischaemic cardio-protective effects; SEVO allowed a more rapid recovery from anaesthesia

20 Sevoflurane

ISO

LVWM abnormalities time to extubation/respiratory functions haemodynamic parameters

20 Isoflurane

Huseidzinović et al. (2007) Croat Med J, Croatia [35] Prospective randomised controlled trial

32 OPCABG

SS

Acceleration of aortic blood flow, CI, HR, mean arterial pressure, and central venous pressure at different time points

SS group showed better CI values at the beginning of ischemia and 15 minutes after ischemia; in the PP group acceleration decreased and remained lower 15 minutes after sternal closure while was increased in the SS group

Cardiac function was better preserved in patients with SS than with PP

16 Sevoflurane

16 Control

Venkatesh et al. (2007) Ann Card Anaesth, India [32] Prospective randomized

Forty OPCAB

SS

Haemodynamic effects amount of analgesia needed postoperative recovery

No differences identified in terms of haemodynamic parameters, depth of anesthesia, and quantity of agent needed; time of awakening and subsequent extubation were significantly less with SS

SS and ISO could both safely used in OPCAB; awakening and extubation time were significantly lower with SS.

20 Isoflurane

ISO

20 Sevoflurne

Lucchinetti et al. (2007) Anesthesiology, Switzerland [37] Prospective randomised trial

20 OPCAB

SS

Troponin, NBP and associate pregnancy-associated plasma protein A release Gene expression profile (atrial biopsies)

NPB and protein A were decrease in SS group; Echo showed preserved post-op LV function in SS group.

SS gene regulatory control of myocardial substrate metabolism predicted postoperative cardiac function in OPCAB patients

10 Propofol

PP

10 Sevoflurane

Guarracino et al. (2006) Journal of Cardiothoracic and Vascular Anesthesia, Italy [41] Prospective randomised trial

One hundred twelve

DES

Troponin release

Post-op peak troponin was significantly lower in DES group

Myocardial damage measured by cardiac troponin release could be reduced by DES during OPCAB

OPCAB

PP

57 Desflurane

(in addition to opiate-based anesthesia)

55 Propofol

Law-Koune (2006) J Cardiothorac Vasc Anesth, France [30] Prospective randomized trial

Eighteen OPCAB

SS-REMI

Troponin release

No difference in troponin release

Study did not support cardio-protective effects of SS

9 Sevoflurane-remifentanil

PP-REMI

9 Propofol-remifentanil

Bein et al. (2005) Anesth Analg, Germany [43] Prospective randomized trial

Fifty-two OPCAB (MIDCAB)

SS

Myocardial function

Myocardial performance index and early to atrial filling velocity ratio in the PP group deteriorated significantly whereas there was no change in the SS group

In patients undergoing MIDCAB surgery, SS preserved myocardial function better than PP

26 Sevoflurane

PP

26 Propofol

Kendall (2004) Anaesthesia, UK [39] Prospective randomized trial

Thirty OPCAB

PP

Troponin release

No significant difference in between groups

No support of ISO as cardioprotective agent was reported

10 Propofol

ISO

10 Isoflurane

ISO/high thoracic epidural analgesia

10 Isoflurane and high thoracic epidural analgesia

Conzen et al. (2003) Anesthesiology, Germany [27] Prospective randomized trial

Twenty OPCAB

SS

Troponin release

Troponin increased significantly more in the PP group rather than in the SS group

Patients receiving SS had less myocardial injury during the first 24 post-op hours than patients with PP

10 Sevoflurane

10 Propofol