Cardiac Surgery
Conditions
Keywords
Cardiac Surgery, Sedation, Intensive care, Volatile anesthesia, Intravenous anesthesia, Pre and post conditioning after cardiac surgery
Brief summary
All patients undergoing cardiac surgery require intraoperative anesthesia and short-term postoperative sedation with anesthetic agents after the procedure when patient is in the intensive care unit (ICU). The clinical data obtained so far are concentrating on intraoperative use volatile agents (preconditioning) resulting in better postoperative cardiac function and less release of biochemical markers of myocardial damage. There are no studies investigating whether postoperative use of volatile agents (post conditioning) in cardiac surgical population is improving outcomes. The aim of the present study is to compare total intravenous anesthesia and postoperative sedation versus total volatile anesthesia and postoperative sedation in cardiac surgical population.
Interventions
DRUGIsoflurane/sevoflurane
Volatile for sedation in the CVICU while intubated
OTHERPropofol
Propofol for sedation in the CVICU
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for coronary artery bypass graft surgery with good ventricular function (grade 1-2 ventricle) * Signed informed consent
Exclusion criteria
* Patients undergoing valvular surgery * Severe kidney or liver disease (creatinine \> 2.5mg.dL-1 and bilirubin \> 2 mg.dL-1) * Patients with known hypersensitivity to any of the trial drugs (propofol, volatile anesthetics), e.g. propofol allergy or malignant hyperthermia (induced by volatile anesthetics) * Patient with poorly controlled diabetes or on oral anti-diabetic medication (inhibit preconditioning caused by volatile anesthetics)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The composite primary end point of the trial will be the development of enzymatic signs of myocardial injury or MI, postoperative low output syndrome, or both. Enzymatic MI will be determined after obtaining serial measurements of troponin. | Measurements of troponin levels will be after induction of anesthesia (baseline) and at 0, 2, 4, 8, and 24 h after arrival into the ICU. |
Secondary
| Measure | Time frame |
|---|---|
| Quality of sedation | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
| Incidence of delirium | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
| Time to readiness for extubation, time to extubation | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
| Length of stay within ICU, readiness for discharge from the unit | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
Countries
Canada
Outcome results
None listed