Journal of cardiothoracic and vascular anesthesia · 2025
TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and Cognitive Outcomes.
СтатьяРандомизированное исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Garg Vipan, Patel Gautham, Mandal Banashree, Kahlon Shubhkarman, Puri Goverdhan Dutt, Kst Shyam, Rawat Amit
Аннотация
OBJECTIVES: To compare the perioperative inflammatory response and early neurocognitive outcomes in adult patients undergoing elective coronary artery bypass grafting (CABG) under total intravenous anesthesia (TIVA) versus volatile anesthesia.
DESIGN: Prospective, randomized controlled trial.
SETTING: A tertiary care academic medical center.
PARTICIPANTS: Fifty adult patients aged 18 to 65 years scheduled for elective on-pump CABG surgery.
INTERVENTIONS: Patients were randomized to receive either propofol-based TIVA (Group P) or sevoflurane-based volatile anesthesia (group S). Standardized surgical and cardiopulmonary bypass protocols were followed in all patients.
MEASUREMENTS AND MAIN RESULTS: Serum interleukin-6 (IL-6) levels were measured preoperatively and at 24 and 48 hours postoperatively. Secondary outcomes included Mini-Mental State Examination scores, ventilation duration, vasoactive-inotropic score, renal function, and intensive care unit stay. IL-6 levels had increased significantly at 24 hours and decreased by 48 hours in both groups, with no significant intergroup difference at any time point. Mini-Mental State Examination scores at 24 and 48 hours were significantly higher in the TIVA group. TIVA was also associated with shorter mechanical ventilation duration. VIS, cardiac function, renal parameters, and intensive care unit stay duration were comparable between groups.
CONCLUSIONS: TIVA and volatile anesthesia resulted in similar perioperative IL-6 responses in patients undergoing CABG. However, TIVA was associated with better early postoperative cognitive function and faster emergence from mechanical ventilation. These findings suggest a potential neurocognitive benefit of TIVA in this surgical population.
DESIGN: Prospective, randomized controlled trial.
SETTING: A tertiary care academic medical center.
PARTICIPANTS: Fifty adult patients aged 18 to 65 years scheduled for elective on-pump CABG surgery.
INTERVENTIONS: Patients were randomized to receive either propofol-based TIVA (Group P) or sevoflurane-based volatile anesthesia (group S). Standardized surgical and cardiopulmonary bypass protocols were followed in all patients.
MEASUREMENTS AND MAIN RESULTS: Serum interleukin-6 (IL-6) levels were measured preoperatively and at 24 and 48 hours postoperatively. Secondary outcomes included Mini-Mental State Examination scores, ventilation duration, vasoactive-inotropic score, renal function, and intensive care unit stay. IL-6 levels had increased significantly at 24 hours and decreased by 48 hours in both groups, with no significant intergroup difference at any time point. Mini-Mental State Examination scores at 24 and 48 hours were significantly higher in the TIVA group. TIVA was also associated with shorter mechanical ventilation duration. VIS, cardiac function, renal parameters, and intensive care unit stay duration were comparable between groups.
CONCLUSIONS: TIVA and volatile anesthesia resulted in similar perioperative IL-6 responses in patients undergoing CABG. However, TIVA was associated with better early postoperative cognitive function and faster emergence from mechanical ventilation. These findings suggest a potential neurocognitive benefit of TIVA in this surgical population.