Sevoflurane Provides Earlier Tracheal Extubation and Assessment of Cognitive Recovery Than Isoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Ellise S. Delphin, Douglas Jackson, Yuriy Gubenko, Andrei Botea, Barry Esrig, William Fritz, Savris Mavridis

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. Design: Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 μg/kg of fentanyl. Setting: Two university hospitals with active cardiac surgery programs. Participants: One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval. Interventions: Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes. Measurements and Main Results: Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 ± 217 minutes and Iso, 257 ± 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03). Conclusions: Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.

Original languageEnglish (US)
Pages (from-to)690-695
Number of pages6
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume21
Issue number5
DOIs
StatePublished - Oct 2007
Externally publishedYes

Fingerprint

Airway Extubation
Off-Pump Coronary Artery Bypass
Isoflurane
Coronary Artery Bypass
Cognition
Anesthetics
Pain
Research Ethics Committees
Fentanyl
sevoflurane
Opioid Analgesics
Nervous System
Thoracic Surgery
Anxiety
Gases
Maintenance

Keywords

  • cognitive recovery
  • fast track
  • inhalation anesthesia
  • off-pump coronary artery bypass surgery
  • recovery from anesthesia
  • time to extubation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sevoflurane Provides Earlier Tracheal Extubation and Assessment of Cognitive Recovery Than Isoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery. / Delphin, Ellise S.; Jackson, Douglas; Gubenko, Yuriy; Botea, Andrei; Esrig, Barry; Fritz, William; Mavridis, Savris.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 21, No. 5, 10.2007, p. 690-695.

Research output: Contribution to journalArticle

@article{b8cc2bd2916c486f96492d36810f65bd,
title = "Sevoflurane Provides Earlier Tracheal Extubation and Assessment of Cognitive Recovery Than Isoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery",
abstract = "Objective: To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. Design: Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 μg/kg of fentanyl. Setting: Two university hospitals with active cardiac surgery programs. Participants: One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval. Interventions: Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes. Measurements and Main Results: Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 ± 217 minutes and Iso, 257 ± 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03). Conclusions: Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.",
keywords = "cognitive recovery, fast track, inhalation anesthesia, off-pump coronary artery bypass surgery, recovery from anesthesia, time to extubation",
author = "Delphin, {Ellise S.} and Douglas Jackson and Yuriy Gubenko and Andrei Botea and Barry Esrig and William Fritz and Savris Mavridis",
year = "2007",
month = "10",
doi = "10.1053/j.jvca.2006.12.008",
language = "English (US)",
volume = "21",
pages = "690--695",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Sevoflurane Provides Earlier Tracheal Extubation and Assessment of Cognitive Recovery Than Isoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

AU - Delphin, Ellise S.

AU - Jackson, Douglas

AU - Gubenko, Yuriy

AU - Botea, Andrei

AU - Esrig, Barry

AU - Fritz, William

AU - Mavridis, Savris

PY - 2007/10

Y1 - 2007/10

N2 - Objective: To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. Design: Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 μg/kg of fentanyl. Setting: Two university hospitals with active cardiac surgery programs. Participants: One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval. Interventions: Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes. Measurements and Main Results: Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 ± 217 minutes and Iso, 257 ± 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03). Conclusions: Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.

AB - Objective: To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. Design: Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 μg/kg of fentanyl. Setting: Two university hospitals with active cardiac surgery programs. Participants: One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval. Interventions: Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes. Measurements and Main Results: Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 ± 217 minutes and Iso, 257 ± 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03). Conclusions: Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.

KW - cognitive recovery

KW - fast track

KW - inhalation anesthesia

KW - off-pump coronary artery bypass surgery

KW - recovery from anesthesia

KW - time to extubation

UR - http://www.scopus.com/inward/record.url?scp=34648834525&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34648834525&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2006.12.008

DO - 10.1053/j.jvca.2006.12.008

M3 - Article

C2 - 17905275

AN - SCOPUS:34648834525

VL - 21

SP - 690

EP - 695

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 5

ER -