Sevoflurane versus Isoflurane in Patients Undergoing Valvular Heart Replacements: A Comparative Study
Introduction: Sevoflurane is a volatile anesthetic agent, which is non-irritant with low solubility and lack of arrhythmogenicity, which makes it an ideal agent for ambulatory anesthesia. The aim of our study is to compare the cardiovascular effects at equivalent minimum alveolar concentration (MAC) doses and the recovery profile of sevoflurane and isoflurane, in patients undergoing valvular replacement surgery.
Materials and Methods: This is a hospital-based, randomized, interventional, comparative study with sample size of seventy participants divided into two groups. Group A (35) received sevoflurane (1MAC) and Group B (35) received isoflurane (1MAC). Patients were of the American Society of Anesthesiologists Grade 2–4. The age group was 20–25 years with body weight of 30–65 kg, undergoing valvular heart surgery. The primary outcomes are to compare the changes in heart rate, systolic and diastolic blood pressures, mean arterial pressure, cardiac output (CO), cardiac index, systemic vascular resistance index (SVRI), and stroke volume variable, during maintenance of anesthesia. The secondary outcomes are the time taken for eye opening on verbal commands and extubation.
Results: There was a decrease in blood pressure, CO, and SVRI with both agents (statistically insignificant, P > 0.05), but comparatively hemodynamics was more stable along with early recovery with sevoflurane (statistically insignificant).
Conclusions: Sevoflurane and isoflurane can safely be used for fast-track anesthesia in patients undergoing valvular heart surgery. Sevoflurane provided a better hemodynamic profile, early awakening, and extubation as compared with isoflurane, even though the difference was insignificant. Thus, sevoflurane with opioids may be preferred in patients undergoing valvular heart surgery
et al. Preconditioning by sevoflurane decreases biochemical markers for
myocardial and renal dysfunction in coronary artery bypass graft surgery:
A double-blinded, placebo-controlled, multicenter study. Anesthesiology
2. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet
3. Venkatesh BG, Mehta Y, Kumar A, Trehan N. Comparison of sevoflurane
and isoflurane in OPCAB surgery. Ann Card Anaesth 2007;10:46-50.
4. Yasuda N, Targ AG, Eger EI 2nd. Solubility of I-653, sevoflurane, isoflurane,
and halothane in human tissues. Anesth Analg 1989;69:370-3.
5. Yasuda N, Lockhart SH, Eger EI 2nd, Weiskopf RB, Liu J, Laster M, et al.
Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth
6. Navarro R, Weiskopf RB, Moore MA, Lockhart S, Eger EI 2nd, Koblin D,
et al. Humans anesthetized with sevoflurane or isoflurane have similar
arrhythmic response to epinephrine. Anesthesiology 1994;80:545-9.
7. Cromheecke S, Pepermans V, Hendrickx E, Lorsomradee S, Ten Broecke PW,
Stockman BA, et al. Cardioprotective properties of sevoflurane in patients
undergoing aortic valve replacement with cardiopulmonary bypass. Anesth
8. Forrest JB, Cahalan MK, Rehder K, Goldsmith CH, Levy WJ, Strunin L,
et al. Multicenter study of general anesthesia. II. Results. Anesthesiology
9. Eger EI 2nd, White AE, Brown CL, Biava CG, Corbett TH,
Stevens WC. A test of the carcinogenicity of enflurane, isoflurane,
halothane, methoxyflurane, and nitrous oxide in mice. Anesth Analg
10. Frink EJ Jr., Malan TP, Atlas M, Dominguez LM, DiNardo JA, Brown BR
Jr. Clinical comparison of sevoflurane and isoflurane in healthy patients.
Anesth Analg 1992;74:241-5.
11. Ebert TJ, Harkin CP, Muzi M. Cardiovascular responses to sevoflurane:
A review. Anesth Analg 1995;81:S11-22.
12. Rolf N, Van Aken H. The cardiovascular effects of sevoflurane. Anaesthesist
1996;45 Suppl 1:S14-21.
13. Bennett SR, Griffin SC. Sevoflurane versus isoflurane in patients undergoing
valvular cardiac surgery. J Cardiothorac Vasc Anesth 2001;15:175-8.
14. Jones PM, Bainbridge D, Chu MW, Fernandes PS, Fox SA, Iglesias I,
et al. Comparison of isoflurane and sevoflurane in cardiac surgery:
A randomized non-inferiority comparative effectiveness trial. Can J
15. Bernard JM, Wouters PF, Doursout MF, Florence B, Chelly JE, Merin RG.
Effects of sevoflurane and isoflurane on cardiac and coronary dynamics in
chronically instrumented dogs. Anesthesiology 1990;72:659-62.
16. 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
17. Hemmerling T, Olivier JF, Le N, Prieto I, Bracco D. Myocardial protection
by isoflurane vs. sevoflurane in ultra-fast-track anaesthesia for off-pump
aortocoronary bypass grafting. Eur J Anaesthesiol 2008;25:230-6.
18. Conzen PF, Fischer S, Detter C, Peter K. Sevoflurane provides greater
protection of the myocardium than propofol in patients undergoing offpump
coronary artery bypass surgery. Anesthesiology 2003;99:826-33.
19. Soliman R, Abukhudair W. Comparison of the myocardial protective effect
of sevoflurane and isoflurane in high-risk cardiac patients undergoing
coronary artery bypass grafting surgery: A randomized study. Egypt J
Cardiothorac Anesth 2017;11:38.20. Xu J, Chang Y, Ouyang B, Lü Z, Li L. Influence of isoflurane and sevoflurane
on metabolism of oxygen free radicals in cardiac valve replacement. Hunan
Yi Ke Da Xue Xue Bao 1998;23:489-91.
21. Kortekaas KA, van der Baan A, Aarts LP, Palmen M, Cobbaert CM,
Verhagen JC, et al. Cardiospecific sevoflurane treatment quenches
inflammation but does not attenuate myocardial cell damage markers:
A proof-of-concept study in patients undergoing mitral valve repair. Br J