Coronary Artery Bypass Graft Triple Vessel
Conditions
Keywords
Volatile Anesthetics, MicroRNA, Off-pump Coronary Artery Bypass Surgery, Internal Mammary Artery, Ascending Aorta
Brief summary
It has been reported that volatile anesthetics preconditioning mediates protection of organ via microRNA. We want to study on the effects of isoflurane preconditioning on expression of microRNA and mRNA in the specimens of internal mammary artery and ascending aorta.
Detailed description
1. Sixty patients scheduled for off-pump coronary artery bypass surgery were randomly assigned to isoflurane wash-in/wash-out group(S-I group, n=30)or propofol intravenous anesthesia group(P group, n=30). 2. Anesthesia and monitoring method All patients were monitored according to the American Society of Anesthesia guidelines and received standard general induction of anesthesia. 3. SI group:10min after intubation,begin to isoflurane wash-in/wash-out operation:isoflurane administration was interrupted for at least 10 min,by washout with a high fresh gas flow(10 l/min)to achieve a MAC value below 0.2. Following the interruption,sevoflurane was again washed in with a high fresh gas flow(6 l/min)to achieve 1 MAC end-tidal concentration as soon as possible,and repeated twice periods of 10 minutes.Discontinuation of the halogenated agent for at least 15 minutes during the last wash out time. 4. P Group:propofol infusion 3-5μg/kg/h. 5. When isoflurane inhaled anesthetic,propofol are stopped infusion.If during this interruption the BIS value increased to\>50,0.5 mg/kg propofol was administered repeatedly in boluses until the BIS value have returned to\<50. 6.1h after isoflurane preconditioning,specimens of internal mammary artery(surplus arterial tissue is obtained from the repair internal mammary artery)and ascending aorta(the stump after ascending aortic punch)will be saved, and before isoflurane preconditioning,1h,3h,5h after isoflurane preconditioning, central venous blood samples will also be drawn.
Interventions
DRUGvolatile anesthetics(isoflurane)
volatile anesthetics wash-in / wash-out operation
DRUGpropofol intravenous anesthesia
propofol infusion 3-5μg / kg / h
Sponsors
Liang Zhang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* age \>18 years * written informed consent; * scheduled procedures; * planned isolated OPCABG(multiple bypass are allowed; planned combined intervention such as CABG plus valve surgery are not allowed); * ejection fraction\> 50%; * NYHA class Ⅱ\ Ⅲ; * serum creatinine \<150μmol / l; * preoperative platelet content \> 100 × 109 / l; * preoperative hemoglobin\> 120 g / l
Exclusion criteria
* pregnancy; * planned valve surgery or surgery on the aorta; * left main coronary artery stenosis\> 75%; * echocardiographic examination revealed moderate to severe mitral, tricuspid, or aortic regurgitation or stenosis; * unstable or ongoing angina; * recent (\< 1 month) or ongoing acute myocardial infarction; * use of sulfonylurea, theophylline or allopurinol; * previous unusual response to an anesthetic agent; * inclusion in other randomised controlled studies in the previous 30 days; (10)any general anesthesia performed in the previous 30 days; * emergency operation (not scheduled); * kidney or liver transplant in medical history, liver cirrhosis (Child B or C); * chronic respiratory disease (such as chronic obstructive pulmonary emphysema)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| microRNA | 1h after isoflurane treatment(specimens of internal mammary artery and ascending aorta stump are saved) |
| NOS3 mRNA,mRNA levels of adhesion molecule selectin -E,vascular cell adhesion molecule -1,vascular endothelial growth factor -1,intercellular adhesion molecule,RhoA and ROK | 1h after isoflurane treatment(specimens of internal mammary artery and ascending aorta stump are saved) |
| phosphatidylinositol-3-kinase,alanine aminotransferase,endothelial nitric oxide synthase | 1h after isoflurane treatment(specimens of internal mammary artery and ascending aorta stump are saved) |
Secondary
| Measure | Time frame |
|---|---|
| Change from microRNA | befor isoflurane treatment,1h,3h,5h after isoflurane treatment(central venous blood samples are drawn) |
| Change from ON content in serum,vascular cell adhesion molecule-1,intercellular adhesion molecules-1,adhesion molecule selectin-E,monocyte chemoattractant protein-1 and vascular endothelial growth factor-1 | befor isoflurane treatment,1h,3h,5h after isoflurane treatment(central venous blood samples are drawn) |
| Change from tumor necrosis factor-a,interleukin 1β,IL-6,IL-8 and IL-10 | befor isoflurane treatment,1h,3h,5h after isoflurane treatment(central venous blood samples are drawn) |
Countries
China
Contacts
Primary ContactJun Ma, MD
Outcome results
None listed