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Analysis Study Research Paper | Anaesthesiology | India | Volume 13 Issue 8, August 2024 | Rating: 4 / 10
Comparison of Cardioprotective Effects of Sevoflurane versus Propofol in Patients of Aneurysmal Subarachnoid Haemorrhage - Single Blind Randomized Clinical Study
Supriya [108] | Deep Shikha [2] | Madhulika Dubey
Abstract: Background: Volatile anaesthetic agents have shown myocardial protective effects on heart and its use may show long term cardio - protective effects in immediate postoperative period. Therefore, this study aims to compare the cardio - protective role of sevoflurane MAC - 2 and sevoflurane MAC - 2.5 versus propofol during aneurysm clipping surgery in patients of subarachnoid haemorrhage SAH. Methods: A total of 90 patients aged 18 - 60 years undergoing clipping for aneurysmal SAH were included in the study. The patients were randomized using sealed - envelope technique into three groups of 30 each. Group 1 - Propofol (1 - 1.5 mg/kg) intravenous, Group 2 & Group 3 - Patients inhaled Sevoflurane. In group - 2, MAC was maintained at 2 and in group 3 MAC was maintained at 2.5. Blood samples were collected from patient before induction of anaesthesia, after surgery, and at 48 hrs post - surgery to detect cardiac injury markers troponin I, CK - MB and BNP levels. Continuous variables with normal distribution were compared between groups using one - way ANOVA, while continuous variables not normally distributed were compared using the Kruskal - Wallis test. The categorical data was analysed using Fischer - Exact test. P - value <0.05 was considered significant. Results: The cTnI level post - operative was found to be significantly higher in group 1 (0.29 ? 0.38 ng/ml) than in group 2 (0.02 ? 0.02 ng/ml) and group 3 (0.01 ? 0.003 ng/ml), p=0.0001. The CK - MB level increased significantly post - operative in group 1 (9.16 ? 13.93 ng/ml) than in group 2 (1.78 ? 1.64 ng/ml) and group 3 (1.69 ? 0.99 ng/ml), p=0.0001. The BNP level increased post - operative and at 48 hours post - operation in the three groups, however increase in BNP level was significantly higher in group 1 (134.53 ? 64.91 pg/ml & 257.88 ? 198.28 pg/ml, respectively) than group 3 (97.55 ? 74.58 pg/ml & 170.36 ? 173.52 pg/ml, respectively), p=0.011 & p=0.010, respectively. The significance of this study lies in its potential to inform clinical decisions regarding the use of anaesthetic agents in aneurysmal subarachnoid hemorrhage surgeries, which could improve patient outcomes by reducing cardiac injury. Conclusions: There is an increase in cardiac enzyme markers levels post - operatively but not raised to values that come under myocardial ischemia. Sevoflurane has a better cardio - protective profile than propofol in patients with SAH.
Keywords: Sevoflurane, Propofol, Cardioprotective, Subarachnoid Hemorrhage, Aneurysm Clipping
Edition: Volume 13 Issue 8, August 2024,
Pages: 17 - 22