A Review of the Effect of Sevoflurane Versus Propofol for Maintenance of General Anesthesia during Cardiopulmonary Bypass
,
Abstract
Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB.
Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024.
Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea.
Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue.
[1] Vervoort D, Lee G, Ghandour H, Guetter CR, Adreak N, Till BM, et al. Global cardiac surgical volume and gaps: trends, targets, and way forward. Ann Thorac Surg Short Rep. 2024; 2(2):320-4.
[2] Bettex DA, Wanner PM, Bosshart M, Balmer C, Knirsch W, Dave H, et al. Role of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial. Interact Cardiovasc Thorac Surg. 2015; 20(2):157-65.
[3] Cardoso TA, Kunst G, Neto CN, de Ribamar Costa Júnior J, Silva CG, Bastos GM, et al. Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial. Trials. 2021; 22:1-0.
[4] De Backer D, Dubois MJ, Schmartz D, Koch M, Ducart A, Barvais L, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg. 2009; 88(5):1396-403.
[5] Duan GY, Duan ZX, Chen H, Chen F, Chen F, Du ZY, et al. Cognitive function and delirium following sevoflurane or propofol anesthesia for valve replacement surgery: A multicenter randomized controlled trial. Kaohsiung J Med Sci. 2023; 39(2):166-74.
[6] Shi Y, Wang W. Application of different anesthetic methods in coronary artery bypass grafting and the effect on postoperative outcome. Exp Ther Med. 2019; 17(1):695-700.
[7] Onk D, Akarsu Ayazoğlu T, Onk OA, Aksüt M, Günay M, Turkmen K, et al. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes. Biomed Res Int. 2016; 2016:3272530.
[8] Shui M, Xue Z, Miao X, Wei C, Wu A. Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. PLoS One. 2021; 16(7):e0254271.
[9] Ren SF, Yu H, Guo YQ, Yu H. Inhalation versus intravenous anesthesia for adults undergoing heart valve surgery: a systematic review and meta-analysis. Minerva Anestesiol. 2019; 85(6):665-675.
[10] Bonanni A, Signori A, Alicino C, Mannucci I, Grasso MA, Martinelli L, et al. Volatile Anesthetics versus Propofol for Cardiac Surgery with Cardiopulmonary Bypass: Meta-analysis of Randomized Trials. Anesthesiology. 2020; 132(6):1429-1446.
[11] Jiao XF, Lin XM, Ni XF, Li HL, Zhang C, Yang CS, et al. Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One. 2019; 14(10):e0224562.
[12] Zhang C, He C, Chen Z, Chen X, Qin J, Xu Y, et al. The effects of volatile anesthetics and propofol in patients undergoing off-pump coronary artery bypass grafting: a systematic review and meta-analysis. Front Cardiovasc Med. 2023; 10:1271557.
[13] Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WA, Schraag S, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine. 2024; 72:102636.
[14] Beverstock J, Park T, Alston RP, Song CCA, Claxton A, Sharkey T, et al. A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia (TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021; 35(4):1096-1105.
[15] Riedel B, Dubowitz J, Yeung J, Jhanji S, Kheterpal S, Avidan MS. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia. Br J Anaesth. 2022; 129(3):284-289.
[16] Ștefan M, Predoi C, Goicea R, Filipescu D. Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery-A Narrative Review. J Clin Med. 2022; 11(20):6031.
[17] Uhlig C, Labus J. Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: a Narrative Review. Curr Anesthesiol Rep. 2021; 11(3):275-283.
[18] Biedrzycka A, Kowalik M, Pawlaczyk R, Jagielak D, Świetlik D, Szymanowicz W, et al. Aortic cross-clamping phase of cardiopulmonary bypass is related to decreased microvascular reactivity after short-term ischaemia of the thenar muscle both under intravenous and volatile anaesthesia: a randomized trial. Interact Cardiovasc Thorac Surg. 2016;23(5):770-778.
[19] Jiang JL, Zhang L, He LL, Yu H, Li XF, Dai SH, et al. Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial. Anesth Analg. 2023; 136(1):60-69.
[20] Landoni G, Guarracino F, Cariello C, Franco A, Baldassarri R, Borghi G, et al. Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study. Br J Anaesth. 2014; 113(6):955-63.
[21] Yang XL, Wang D, Zhang GY, Guo XL. Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass. BMC Anesthesiol. 2017; 17(1):37.
[22] Yoo YC, Shim JK, Song Y, Yang SY, Kwak YL. Anesthetics influence the incidence of acute kidney injury following valvular heart surgery. Kidney Int. 2014; 86(2):414-22.
[23] O'Gara BP, Shaefi S, Gasangwa DV, Patxot M, Beydoun N, Mueller AL, et al. Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2022;36(10):3747-3757.
[24] Baiterek B, Mustafin A. Effects of sevoflurane and propofol on hemodynamics during cardiac surgery: A randomized controlled clinical trial. J CLIN MED KAZ. 2023;20(1):35-9.
[25] Aykut A, Salman N, Demir ZA, Özgök A, Günaydın S. Comparison of Propofol and Sevoflurane Anaesthesia in Terms of Postoperative Nausea-Vomiting Complication in Cardiac Surgery Patients Undergoing Enhanced Recovery After Surgery Protocol: A Prospective Randomized Study. Turk J Anaesthesiol Reanim. 2024; 52(3):113-121.
[26] Flinspach AN, Raimann FJ, Kaiser P, Pfaff M, Zacharowski K, Neef V, et al. Volatile versus propofol sedation after cardiac valve surgery: a single-center prospective randomized controlled trial. Crit Care. 2024; 28(1):111.
[2] Bettex DA, Wanner PM, Bosshart M, Balmer C, Knirsch W, Dave H, et al. Role of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial. Interact Cardiovasc Thorac Surg. 2015; 20(2):157-65.
[3] Cardoso TA, Kunst G, Neto CN, de Ribamar Costa Júnior J, Silva CG, Bastos GM, et al. Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial. Trials. 2021; 22:1-0.
[4] De Backer D, Dubois MJ, Schmartz D, Koch M, Ducart A, Barvais L, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg. 2009; 88(5):1396-403.
[5] Duan GY, Duan ZX, Chen H, Chen F, Chen F, Du ZY, et al. Cognitive function and delirium following sevoflurane or propofol anesthesia for valve replacement surgery: A multicenter randomized controlled trial. Kaohsiung J Med Sci. 2023; 39(2):166-74.
[6] Shi Y, Wang W. Application of different anesthetic methods in coronary artery bypass grafting and the effect on postoperative outcome. Exp Ther Med. 2019; 17(1):695-700.
[7] Onk D, Akarsu Ayazoğlu T, Onk OA, Aksüt M, Günay M, Turkmen K, et al. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes. Biomed Res Int. 2016; 2016:3272530.
[8] Shui M, Xue Z, Miao X, Wei C, Wu A. Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. PLoS One. 2021; 16(7):e0254271.
[9] Ren SF, Yu H, Guo YQ, Yu H. Inhalation versus intravenous anesthesia for adults undergoing heart valve surgery: a systematic review and meta-analysis. Minerva Anestesiol. 2019; 85(6):665-675.
[10] Bonanni A, Signori A, Alicino C, Mannucci I, Grasso MA, Martinelli L, et al. Volatile Anesthetics versus Propofol for Cardiac Surgery with Cardiopulmonary Bypass: Meta-analysis of Randomized Trials. Anesthesiology. 2020; 132(6):1429-1446.
[11] Jiao XF, Lin XM, Ni XF, Li HL, Zhang C, Yang CS, et al. Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One. 2019; 14(10):e0224562.
[12] Zhang C, He C, Chen Z, Chen X, Qin J, Xu Y, et al. The effects of volatile anesthetics and propofol in patients undergoing off-pump coronary artery bypass grafting: a systematic review and meta-analysis. Front Cardiovasc Med. 2023; 10:1271557.
[13] Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WA, Schraag S, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine. 2024; 72:102636.
[14] Beverstock J, Park T, Alston RP, Song CCA, Claxton A, Sharkey T, et al. A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia (TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021; 35(4):1096-1105.
[15] Riedel B, Dubowitz J, Yeung J, Jhanji S, Kheterpal S, Avidan MS. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia. Br J Anaesth. 2022; 129(3):284-289.
[16] Ștefan M, Predoi C, Goicea R, Filipescu D. Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery-A Narrative Review. J Clin Med. 2022; 11(20):6031.
[17] Uhlig C, Labus J. Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: a Narrative Review. Curr Anesthesiol Rep. 2021; 11(3):275-283.
[18] Biedrzycka A, Kowalik M, Pawlaczyk R, Jagielak D, Świetlik D, Szymanowicz W, et al. Aortic cross-clamping phase of cardiopulmonary bypass is related to decreased microvascular reactivity after short-term ischaemia of the thenar muscle both under intravenous and volatile anaesthesia: a randomized trial. Interact Cardiovasc Thorac Surg. 2016;23(5):770-778.
[19] Jiang JL, Zhang L, He LL, Yu H, Li XF, Dai SH, et al. Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial. Anesth Analg. 2023; 136(1):60-69.
[20] Landoni G, Guarracino F, Cariello C, Franco A, Baldassarri R, Borghi G, et al. Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study. Br J Anaesth. 2014; 113(6):955-63.
[21] Yang XL, Wang D, Zhang GY, Guo XL. Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass. BMC Anesthesiol. 2017; 17(1):37.
[22] Yoo YC, Shim JK, Song Y, Yang SY, Kwak YL. Anesthetics influence the incidence of acute kidney injury following valvular heart surgery. Kidney Int. 2014; 86(2):414-22.
[23] O'Gara BP, Shaefi S, Gasangwa DV, Patxot M, Beydoun N, Mueller AL, et al. Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2022;36(10):3747-3757.
[24] Baiterek B, Mustafin A. Effects of sevoflurane and propofol on hemodynamics during cardiac surgery: A randomized controlled clinical trial. J CLIN MED KAZ. 2023;20(1):35-9.
[25] Aykut A, Salman N, Demir ZA, Özgök A, Günaydın S. Comparison of Propofol and Sevoflurane Anaesthesia in Terms of Postoperative Nausea-Vomiting Complication in Cardiac Surgery Patients Undergoing Enhanced Recovery After Surgery Protocol: A Prospective Randomized Study. Turk J Anaesthesiol Reanim. 2024; 52(3):113-121.
[26] Flinspach AN, Raimann FJ, Kaiser P, Pfaff M, Zacharowski K, Neef V, et al. Volatile versus propofol sedation after cardiac valve surgery: a single-center prospective randomized controlled trial. Crit Care. 2024; 28(1):111.
| Files | ||
| Issue | Article in Press |
|
| Section | Review Article(s) | |
| Keywords | ||
| Cardiac surgical procedures Cardiopulmonary bypass Cognitive dysfunction Inflammation Sevoflurane | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Firouzbakht B, Hakiminia B, Dehghanpisheh L. A Review of the Effect of Sevoflurane Versus Propofol for Maintenance of General Anesthesia during Cardiopulmonary Bypass. Arch Anesth & Crit Care. 2025;.
