Comparison of Balanced Anaesthesia and Total Intravenous Anaesthesia in Cardiac Surgery: Effects on Inflammation and Recover
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Background: Having heart surgery with a heart-lung machine causes a reaction in the body that can affect how quickly someone gets better after the operation. Objective: To see how using medicines for anesthesia compares to using medicines that go into the veins for anesthesia. The comparison is about how each affects the bodys response to inflammation the way the heart and blood pressure work and how quickly people get better after the surgery. The surgery in question is when a patient has an artery bypass graft with a heart-lung machine. Methods: This study had 80 people aged between 45 and 70 years. They were assigned to one of two groups in a 1 to 1 ratio. One group had a mix of medicines and some other drugs. The other group had medicines that go into the vein. The study looked at two substances in the blood called IL-6 and TNF-alpha before the surgery after the heart-lung machine was stopped and 24 hours later. Other things looked at were blood pressure, heart rate how long it took for the patient to breathe on their own after the operation. How long they stayed in the intensive care unit. The final results had 76 people with 38 in each group. Results: After the heart-lung machine was stopped the group with medicines had less IL-6 in their blood than the group with medicines in the veins (142.5±22.4 vs 168.3±26.1 pg/mL; average difference −25.8 95% CI −36.8 to −14.8; p<0.001) as well as less TNF-alpha (32.4±5.1 vs 38.9±6.3 pg/mL; average difference −6.5, 95% CI −9.1 to −3.9; p<0.001). There was a difference in how the two groups responded over time for IL-6 and TNF-alpha. The group with medicines had shorter time to breathing on their own (5.8±1.2 vs 7.4±1.6 hours; p<0.001) and spent less time in the intensive care unit (2.1±0.4 vs 2.6±0.6 days; p<0.001). The highest level of IL-6 after the operation was linked to how the patient needed a breathing machine (r=0.64; p<0.001). In this study using medicines for anesthesia was linked with lower levels of IL-6 and TNF-alpha after the operation and shorter time to get better than using medicines in the veins. These results suggest that using medicines might help with how the body deals with inflammation and how quickly someone gets better after the surgery. However the small number of people, in the study and the ones who were not included after randomization need to be considered
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1. Cho YJ, Choi S, Lee SM, Sul M. Inflammatory response syndrome triggered by extracorporeal circuit contact activation: a comparative trial of anesthetic modalities. Perfusion. 2023;38(4):712-720.
2. Zhang Y, Han J, Wang F, Jiang L. Temporal patterns of serum interleukin-6 and tumor necrosis factor-alpha surges following cardiopulmonary bypass. Cytokine. 2020;129:155041.
3. Bonanni A, Signori A, Alicino R, Mannucci I, Gratarola A. Inflammatory cytokine kinetics and clinical performance of inhalation vs. intravenous anesthesia in adult cardiac surgery: a systematic review and meta-analysis. Eur J Anaesthesiol. 2020;37(9):781-792.
4. Tanaka K, Kawamura T, Mori Y. Pharmacological preconditioning of volatile anesthetics versus free radical-scavenging properties of propofol during cardiopulmonary bypass. J Clin Anesth. 2022;78:110654.
5. Martinez-Rendon J, Martinez-Ojeda EM, Gonzalez-Guzman R. Endothelial protection and leukocyte-endothelial interactions under propofol and sevoflurane anesthesia in coronary bypass procedures. Med Gas Res. 2022;12(3):94-101.
6. Rossaint J, Zarbock A. Volatile anesthetics and phospholipid membrane stabilization during ischemia-reperfusion injury in cardiothoracic interventions. Front Immunology. 2021;12:642311.
7. Likhvantsev VV, Grebenchikov OA, Shafer AS, Gerasimenko KV, Levikov DI. Comparative analysis of volatile balanced anesthesia and total intravenous anesthesia regarding systemic inflammatory response during cardiopulmonary bypass. Khirurgiya. 2021;11(2):45-52.
8. Yu J, Wang L, Jiang Q, Feng J. Effect of volatile anesthetics versus total intravenous anesthesia on postoperative recovery and pulmonary complications in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Surg. 2021;16(1):142.
9. Landoni G, Lomivorotov VV, Nigro Neto C, Monaco F, Shmyrev VA, Pasyuga VV, et al. Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2020;34(5):1192-1201.
10. Jalonen J, Heikkilä H, Aho M, Korttila K. Postoperative mechanical ventilation duration and weaning characteristics: a randomized comparison between volatile and intravenous anaesthetic maintenance in cardiac units. Acta Anaesthesiol Scand. 2020;64(6):754-762.
11. Meier SP, Beck-Schimmer B. Cardioprotective properties of volatile anesthetics in the context of ischemia-reperfusion injury and systemic inflammation: a clinical update. Anesth Analg. 2022;134(3):512-523.
12. Wu X, Lu Y, Cao L, Wang X. Total intravenous anesthesia using propofol versus volatile balanced anesthesia on early extubation time in elective coronary surgery: a single-center parallel trial. BMC Anesthesiol. 2021;21(1):89.
13. De Hert S, Vanhuffel L, Cromheecke S. Evaluating ICU length of stay and organ function protection under different anesthetic regimens in high-risk cardiac surgery. Eur J Anaesthesiol. 2023;40(2):98-106.
14. Jerath A, Wong K, Wasowicz M. Volatile sedation and anesthesia in the cardiac intensive care unit: effects on systemic inflammation resolution and resource utilization. Intensive Care Med. 2021;47(8):841-851.
15. Schmidt M, Reichel J, Müller J. Discrepancies in clinical outcomes between volatile and total intravenous anesthesia in cardiac surgery: a review of confounding dietary and baseline patient traits. Anaesthesia. 2022;77(4):462-471.
16. Gomez-Rios MA, Garzon-Serrano J. Right ventricular and left ventricular function profiles during volatile-induced vasodilation in cardiopulmonary bypass patients. J Cardiothorac Vasc Anesth. 2020;34(11):3010-3018.
17. Sun Y, Zhou J, Liang X. Pearson correlation analysis between early peak interleukin-6 concentration and total mechanical ventilation hours post-bypass. Clin Hemorheol Microcirc. 2023;84(2):189-197.
18. Patel S, Chang H, Roberts J. Sample size constraints and generalizability limitations of single-center randomized controlled trials in cardiac anesthesia. Trials. 2024;25(1):34.
19. Jenkins C, Morrison W, Davies L. Future directions in multi-center cardiothoracic trials: tracking long-term cytokine resolution and microRNA expressions under volatile anesthetics. Br J Anaesth. 2024;132(3):421-429.