Альманах клинической медицины. 2017; 45: 172-180
Анестетическое прекондиционирование в кардиохирургии
https://doi.org/10.18786/2072-0505-2017-45-3-172-180Аннотация
Проблема защиты миокарда в кардиохирургии актуальна в связи с возросшим числом вмешательств и тяжестью их осложнений, обусловленных состоянием пациента, патофизиологией искусственного кровообращения и применяемых методов протезирования жизненных функций. Окислительный стресс и образующиеся активные формы кислорода, будучи следствием указанных процессов, ведут к системным повреждениям: острой сердечной недостаточности, нарушению функции центральной нервной системы, острому почечному повреждению. Короткие эпизоды ишемии перед длительной гипоксией с последующей реперфузией уменьшают повреждение кардиомиоцитов. Этот феномен получил название ишемического прекондиционирования. Схожий эффект вызывают ингаляционные анестетики. Экспериментальные и клинические данные, полученные при изучении анестетического прекондиционирования, дают основания рассматривать ингаляционную анестезию галогенсодержащими препаратами как способ защиты миокарда от повреждающего воздействия активных форм кислорода, образующихся при окислительном стрессе в кардиохирургии. Рассмотренные в обзоре исследования показали преимущества ингаляционных анестетиков перед тотальной внутривенной анестезией в эффективности кардиопротекции, а самое главное, в возможном уменьшении летальности у пациентов после аортокоронарного шунтирования. Уровень доказательности влияния анестетического прекондиционирования на отдаленную смертность в данных исследованиях недостаточно высок, поэтому для подтверждения указанных результатов необходимо проведение большого многоцентрового рандомизированного контролируемого исследования.
Список литературы
1. Herbertson M. Recombinant activated factor VII in cardiac surgery. Blood Coagul Fibrinolysis. 2004;15 Suppl 1:S31–2.
2. Landoni G, Rodseth RN, Santini F, Ponschab M, Ruggeri L, Székely A, Pasero D, Augoustides JG, Del Sarto PA, Krzych LJ, Corcione A, Slullitel A, Cabrini L, Le Manach Y, Almeida RM, Bignami E, Biondi-Zoccai G, Bove T, Caramelli F, Cariello C, Carpanese A, Clarizia L, Comis M, Conte M, Covello RD, De Santis V, Feltracco P, Giordano G, Pittarello D, Gottin L, Guarracino F, Morelli A, Musu M, Pala G, Pasin L, Pezzoli I, Paternoster G, Remedi R, Roasio A, Zucchetti M, Petrini F, Finco G, Ranieri M, Zangrillo A. Randomized evidence for reduction of perioperative mortality. J Cardiothorac Vasc Anesth. 2012;26(5): 764–72. doi: 10.1053/j.jvca.2012.04.018.
3. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22): 2117–27. doi: 10.1056/NEJMsa035205.
4. Du SL, Zeng XZ, Tian JW, Ai J, Wan J, He JX. Advanced oxidation protein products in predicting acute kidney injury following cardiac surgery. Biomarkers. 2015;20(3): 206–11. doi: 10.3109/1354750X.2015.1062917.
5. Lamb NJ, Quinlan GJ, Westerman ST, Gutteridge JM, Evans TW. Nitration of proteins in bronchoalveolar lavage fluid from patients with acute respiratory distress syndrome receiving inhaled nitric oxide. Am J Respir Crit Care Med. 1999;160(3): 1031–4. doi: 10.1164/ajrccm.160.3.9810048.
6. Zhang YH, Jin CZ, Jang JH, Wang Y. Molecular mechanisms of neuronal nitric oxide synthase in cardiac function and pathophysiology. J Physiol. 2014;592(15): 3189–200. doi: 10.1113/jphysiol.2013.270306.
7. Лихванцев ВВ, ред. Ингаляционная индукция и поддержание анестезии. М.: МИА; 2013. 320 с.
8. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986;74(5): 1124–36. doi: https://doi.org/10.1161/01.CIR.74.5.1124.
9. Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E. Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998;97(18): 1848–67. doi: https://doi.org/10.1161/01.CIR.97.18.1848.
10. Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res. 1990;66(4): 913–31. doi: https://doi.org/10.1161/01.RES.66.4.913.
11. Cohen MV, Baines CP, Downey JM. Ischemic preconditioning: from adenosine receptor to KATP channel. Annu Rev Physiol. 2000;62:79– 109. doi: 10.1146/annurev.physiol.62.1.79.
12. Cason BA, Gamperl AK, Slocum RE, Hickey RF. Anesthetic-induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Anesthesiology. 1997;87(5): 1182–90.
13. Weber NC, Preckel B, Schlack W. The effect of anaesthetics on the myocardium – new insights into myocardial protection. Eur J Anaesthesiol. 2005;22(9): 647–57.
14. Schlack W, Hollmann M, Stunneck J, Thämer V. Effect of halothane on myocardial reoxygenation injury in the isolated rat heart. Br J Anaesth. 1996;76(6): 860–7.
15. De Hert SG, Turani F, Mathur S, Stowe DF. Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg. 2005;100(6): 1584–93. doi: 10.1213/01.ANE.0000153483.61170.0C.
16. Bolli R, Marbán E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev. 1999;79(2): 609–34.
17. Лихванцев ВВ, Мороз ВВ, Гребенчиков ОА, Гороховатский ЮИ, Заржецкий ЮВ, Тимошин СС, Левиков ДИ, Шайбакова ВЛ. Ишемическое и фармакологическое прекондиционирование. Общая реаниматология. 2011;7(6): 59–65. doi: 10.15360/1813- 9779-2011-6-59.
18. Tanaka K, Weihrauch D, Ludwig LM, Kersten JR, Pagel PS, Warltier DC. Mitochondrial adenosine triphosphate-regulated potassium channel opening acts as a trigger for isoflurane-induced preconditioning by generating reactive oxygen species. Anesthesiology. 2003;98(4): 935–43.
19. Tanaka K, Weihrauch D, Kehl F, Ludwig LM, LaDisa JF Jr, Kersten JR, Pagel PS, Warltier DC. Mechanism of preconditioning by isoflurane in rabbits: a direct role for reactive oxygen species. Anesthesiology. 2002;97(6): 1485–90.
20. Шевченко ЮЛ, Гороховатский ЮИ, Азизова ОА, Гудымович ВГ. Севофлюран в кардиохирургии. Кардиология и сердечно-сосудистая хирургия. 2009;2(2): 58–65.
21. Chen W, Gabel S, Steenbergen C, Murphy E. A redox-based mechanism for cardioprotection induced by ischemic preconditioning in perfused rat heart. Circ Res. 1995;77(2): 424–9. doi: https://doi.org/10.1161/01.RES.77.2.424.
22. Griffiths EJ, Halestrap AP. Mitochondrial non-specific pores remain closed during cardiac ischaemia, but open upon reperfusion. Biochem J. 1995;307(Pt 1): 93–8. doi: 10.1042/bj3070093.
23. Zorov DB, Filburn CR, Klotz LO, Zweier JL, Sollott SJ. Reactive oxygen species (ROS)- induced ROS release: a new phenomenon accompanying induction of the mitochondrial permeability transition in cardiac myocytes. J Exp Med. 2000;192(7): 1001–14.
24. Stumpner J, Tischer-Zeitz T, Frank A, Lotz C, Redel A, Lange M, Kehl F, Roewer N, Smul T. The role of cyclooxygenase-1 and -2 in sevoflurane- induced postconditioning against myocardial infarction. Semin Cardiothorac Vasc Anesth. 2014;18(3): 272–80. doi: 10.1177/1089253214523683.
25. Hunter DR, Haworth RA. The Ca2+-induced membrane transition in mitochondria. I. The protective mechanisms. Arch Biochem Biophys. 1979;195(2): 453–9.
26. Crompton M. Mitochondrial intermembrane junctional complexes and their role in cell death. J Physiol. 2000;529(Pt 1): 11–21. doi: 10.1111/j.1469-7793.2000.00011.x.
27. Kroemer G, Dallaporta B, Resche-Rigon M. The mitochondrial death/life regulator in apoptosis and necrosis. Annu Rev Physiol. 1998;60:619–42. doi: 10.1146/annurev.physiol.60.1.619.
28. Haunstetter A, Izumo S. Future perspectives and potential implications of cardiac myocyte apoptosis. Cardiovasc Res. 2000;45(3): 795–801.
29. Juhaszova M, Zorov DB, Yaniv Y, Nuss HB, Wang S, Sollott SJ. Role of glycogen synthase kinase-3beta in cardioprotection. Circ Res. 2009;104(11): 1240–52. doi: 10.1161/CIRCRESAHA.109.197996.
30. Kockeritz L, Doble B, Patel S, Woodgett JR. Glycogen synthase kinase-3 – an overview of an over-achieving protein kinase. Curr Drug Targets. 2006;7(11): 1377–88. doi: 10.2174/1389450110607011377.
31. Belhomme D, Peynet J, Louzy M, Launay JM, Kitakaze M, Menasché P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation. 1999;100(19 Suppl): II340–4. doi: https://doi.org/10.1161/01.CIR.100.suppl_2.II-340.
32. Tomai F, De Paulis R, Penta de Peppo A, Colagrande L, Caprara E, Polisca P, De Matteis G, Ghini AS, Forlani S, Colella D, Chiariello L. Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol. 1999;29(9): 1007–14.
33. Julier K, da Silva R, Garcia C, Bestmann L, Frascarolo P, Zollinger A, Chassot PG, Schmid ER, Turina MI, von Segesser LK, Pasch T, Spahn DR, Zaugg M. 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. 2003;98(6): 1315–27.
34. De Hert SG, ten Broecke PW, Mertens E, Van Sommeren EW, De Blier IG, Stockman BA, Rodrigus IE. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology. 2002;97(1): 42–9.
35. Yildirim V, Doganci S, Aydin A, Bolcal C, Demirkilic U, Cosar A. Cardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study. Heart Surg Forum. 2009;12(1):E1–9. doi: 10.1532/HSF98.20081137.
36. Bignami E, Biondi-Zoccai G, Landoni G, Fochi O, Testa V, Sheiban I, Giunta F, Zangrillo A. Volatile anesthetics reduce mortality in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(5): 594–9. doi: 10.1053/j.jvca.2009.01.022.
37. Jakobsen CJ, Berg H, Hindsholm KB, Faddy N, Sloth E. The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures. J Cardiothorac Vasc Anesth. 2007;21(5): 664–71. doi: 10.1053/j.jvca.2007.03.002.
38. Landoni G, Greco T, Biondi-Zoccai G, Nigro Neto C, Febres D, Pintaudi M, Pasin L, Cabrini L, Finco G, Zangrillo A. Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. Br J Anaesth. 2013;111(6): 886–96. doi: 10.1093/bja/aet231.
39. De Hert S, Vlasselaers D, Barbé R, Ory JP, Dekegel D, Donnadonni R, Demeere JL, Mulier J, Wouters P. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia. 2009;64(9): 953–60. doi: 10.1111/j.1365-2044.2009.06008.x.
40. Likhvantsev VV, Landoni G, Levikov DI, Grebenchikov OA, Skripkin YV, Cherpakov RA. Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial. J Cardiothorac Vasc Anesth. 2016;30(5): 1221–7. doi: 10.1053/j.jvca.2016.02.030.
41. Landoni G, Augoustides JG, Guarracino F, Santini F, Ponschab M, Pasero D, Rodseth RN, Biondi- Zoccai G, Silvay G, Salvi L, Camporesi E, Comis M, Conte M, Bevilacqua S, Cabrini L, Cariello C, Caramelli F, De Santis V, Del Sarto P, Dini D, Forti A, Galdieri N, Giordano G, Gottin L, Greco M, Maglioni E, Mantovani L, Manzato A, Meli M, Paternoster G, Pittarello D, Rana NK, Ruggeri L, Salandin V, Sangalli F, Zambon M, Zucchetti M, Bignami E, Alfieri O, Zangrillo A. Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(1): 9–19.
Almanac of Clinical Medicine. 2017; 45: 172-180
Anesthetic preconditioning in cardiac surgery
https://doi.org/10.18786/2072-0505-2017-45-3-172-180Abstract
The problem of myocardial protection in cardiac surgery is a challenge due to an increased number of interventions and severity of their complications related to the patient's status, pathophysiology of the artificial circulation and the used techniques for replacement of vital functions. Oxidative stress and formation of active oxygen species, as a consequence of the above mentioned processes, may result in systemic injury, such as acute heart failure, central nervous system dysfunction and acute renal injury. Short ischemic episodes before prolonged hypoxia with subsequent reperfusion can decrease cardiomyocyte injury. This phenomenon has been referred to as ischemic preconditioning. A similar effect is caused by inhalation anesthetics. Experimental and clinical data on anesthetic preconditioning suggest that inhalation anesthesia with halogen-containing agents may be used as a method to protect the myocardium from damage by active oxygen species produced during the periods of oxidative stress in cardiac surgery. Studies analyzed in this review have shown benefits of inhalation anesthetics, compared to total intravenous anesthesia, such as effective cardiac protection and, what is most important, in potential reduction of mortality after coronary bypass grafting. The level of evidence for the effects of anesthetic preconditioning on long-term mortality in these studies was not high enough; therefore, a large multicenter randomized controlled trial is needed to confirm these results.
References
1. Herbertson M. Recombinant activated factor VII in cardiac surgery. Blood Coagul Fibrinolysis. 2004;15 Suppl 1:S31–2.
2. Landoni G, Rodseth RN, Santini F, Ponschab M, Ruggeri L, Székely A, Pasero D, Augoustides JG, Del Sarto PA, Krzych LJ, Corcione A, Slullitel A, Cabrini L, Le Manach Y, Almeida RM, Bignami E, Biondi-Zoccai G, Bove T, Caramelli F, Cariello C, Carpanese A, Clarizia L, Comis M, Conte M, Covello RD, De Santis V, Feltracco P, Giordano G, Pittarello D, Gottin L, Guarracino F, Morelli A, Musu M, Pala G, Pasin L, Pezzoli I, Paternoster G, Remedi R, Roasio A, Zucchetti M, Petrini F, Finco G, Ranieri M, Zangrillo A. Randomized evidence for reduction of perioperative mortality. J Cardiothorac Vasc Anesth. 2012;26(5): 764–72. doi: 10.1053/j.jvca.2012.04.018.
3. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22): 2117–27. doi: 10.1056/NEJMsa035205.
4. Du SL, Zeng XZ, Tian JW, Ai J, Wan J, He JX. Advanced oxidation protein products in predicting acute kidney injury following cardiac surgery. Biomarkers. 2015;20(3): 206–11. doi: 10.3109/1354750X.2015.1062917.
5. Lamb NJ, Quinlan GJ, Westerman ST, Gutteridge JM, Evans TW. Nitration of proteins in bronchoalveolar lavage fluid from patients with acute respiratory distress syndrome receiving inhaled nitric oxide. Am J Respir Crit Care Med. 1999;160(3): 1031–4. doi: 10.1164/ajrccm.160.3.9810048.
6. Zhang YH, Jin CZ, Jang JH, Wang Y. Molecular mechanisms of neuronal nitric oxide synthase in cardiac function and pathophysiology. J Physiol. 2014;592(15): 3189–200. doi: 10.1113/jphysiol.2013.270306.
7. Likhvantsev VV, red. Ingalyatsionnaya induktsiya i podderzhanie anestezii. M.: MIA; 2013. 320 s.
8. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986;74(5): 1124–36. doi: https://doi.org/10.1161/01.CIR.74.5.1124.
9. Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E. Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998;97(18): 1848–67. doi: https://doi.org/10.1161/01.CIR.97.18.1848.
10. Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res. 1990;66(4): 913–31. doi: https://doi.org/10.1161/01.RES.66.4.913.
11. Cohen MV, Baines CP, Downey JM. Ischemic preconditioning: from adenosine receptor to KATP channel. Annu Rev Physiol. 2000;62:79– 109. doi: 10.1146/annurev.physiol.62.1.79.
12. Cason BA, Gamperl AK, Slocum RE, Hickey RF. Anesthetic-induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Anesthesiology. 1997;87(5): 1182–90.
13. Weber NC, Preckel B, Schlack W. The effect of anaesthetics on the myocardium – new insights into myocardial protection. Eur J Anaesthesiol. 2005;22(9): 647–57.
14. Schlack W, Hollmann M, Stunneck J, Thämer V. Effect of halothane on myocardial reoxygenation injury in the isolated rat heart. Br J Anaesth. 1996;76(6): 860–7.
15. De Hert SG, Turani F, Mathur S, Stowe DF. Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg. 2005;100(6): 1584–93. doi: 10.1213/01.ANE.0000153483.61170.0C.
16. Bolli R, Marbán E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev. 1999;79(2): 609–34.
17. Likhvantsev VV, Moroz VV, Grebenchikov OA, Gorokhovatskii YuI, Zarzhetskii YuV, Timoshin SS, Levikov DI, Shaibakova VL. Ishemicheskoe i farmakologicheskoe prekonditsionirovanie. Obshchaya reanimatologiya. 2011;7(6): 59–65. doi: 10.15360/1813- 9779-2011-6-59.
18. Tanaka K, Weihrauch D, Ludwig LM, Kersten JR, Pagel PS, Warltier DC. Mitochondrial adenosine triphosphate-regulated potassium channel opening acts as a trigger for isoflurane-induced preconditioning by generating reactive oxygen species. Anesthesiology. 2003;98(4): 935–43.
19. Tanaka K, Weihrauch D, Kehl F, Ludwig LM, LaDisa JF Jr, Kersten JR, Pagel PS, Warltier DC. Mechanism of preconditioning by isoflurane in rabbits: a direct role for reactive oxygen species. Anesthesiology. 2002;97(6): 1485–90.
20. Shevchenko YuL, Gorokhovatskii YuI, Azizova OA, Gudymovich VG. Sevoflyuran v kardiokhirurgii. Kardiologiya i serdechno-sosudistaya khirurgiya. 2009;2(2): 58–65.
21. Chen W, Gabel S, Steenbergen C, Murphy E. A redox-based mechanism for cardioprotection induced by ischemic preconditioning in perfused rat heart. Circ Res. 1995;77(2): 424–9. doi: https://doi.org/10.1161/01.RES.77.2.424.
22. Griffiths EJ, Halestrap AP. Mitochondrial non-specific pores remain closed during cardiac ischaemia, but open upon reperfusion. Biochem J. 1995;307(Pt 1): 93–8. doi: 10.1042/bj3070093.
23. Zorov DB, Filburn CR, Klotz LO, Zweier JL, Sollott SJ. Reactive oxygen species (ROS)- induced ROS release: a new phenomenon accompanying induction of the mitochondrial permeability transition in cardiac myocytes. J Exp Med. 2000;192(7): 1001–14.
24. Stumpner J, Tischer-Zeitz T, Frank A, Lotz C, Redel A, Lange M, Kehl F, Roewer N, Smul T. The role of cyclooxygenase-1 and -2 in sevoflurane- induced postconditioning against myocardial infarction. Semin Cardiothorac Vasc Anesth. 2014;18(3): 272–80. doi: 10.1177/1089253214523683.
25. Hunter DR, Haworth RA. The Ca2+-induced membrane transition in mitochondria. I. The protective mechanisms. Arch Biochem Biophys. 1979;195(2): 453–9.
26. Crompton M. Mitochondrial intermembrane junctional complexes and their role in cell death. J Physiol. 2000;529(Pt 1): 11–21. doi: 10.1111/j.1469-7793.2000.00011.x.
27. Kroemer G, Dallaporta B, Resche-Rigon M. The mitochondrial death/life regulator in apoptosis and necrosis. Annu Rev Physiol. 1998;60:619–42. doi: 10.1146/annurev.physiol.60.1.619.
28. Haunstetter A, Izumo S. Future perspectives and potential implications of cardiac myocyte apoptosis. Cardiovasc Res. 2000;45(3): 795–801.
29. Juhaszova M, Zorov DB, Yaniv Y, Nuss HB, Wang S, Sollott SJ. Role of glycogen synthase kinase-3beta in cardioprotection. Circ Res. 2009;104(11): 1240–52. doi: 10.1161/CIRCRESAHA.109.197996.
30. Kockeritz L, Doble B, Patel S, Woodgett JR. Glycogen synthase kinase-3 – an overview of an over-achieving protein kinase. Curr Drug Targets. 2006;7(11): 1377–88. doi: 10.2174/1389450110607011377.
31. Belhomme D, Peynet J, Louzy M, Launay JM, Kitakaze M, Menasché P. Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation. 1999;100(19 Suppl): II340–4. doi: https://doi.org/10.1161/01.CIR.100.suppl_2.II-340.
32. Tomai F, De Paulis R, Penta de Peppo A, Colagrande L, Caprara E, Polisca P, De Matteis G, Ghini AS, Forlani S, Colella D, Chiariello L. Beneficial impact of isoflurane during coronary bypass surgery on troponin I release. G Ital Cardiol. 1999;29(9): 1007–14.
33. Julier K, da Silva R, Garcia C, Bestmann L, Frascarolo P, Zollinger A, Chassot PG, Schmid ER, Turina MI, von Segesser LK, Pasch T, Spahn DR, Zaugg M. 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. 2003;98(6): 1315–27.
34. De Hert SG, ten Broecke PW, Mertens E, Van Sommeren EW, De Blier IG, Stockman BA, Rodrigus IE. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology. 2002;97(1): 42–9.
35. Yildirim V, Doganci S, Aydin A, Bolcal C, Demirkilic U, Cosar A. Cardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study. Heart Surg Forum. 2009;12(1):E1–9. doi: 10.1532/HSF98.20081137.
36. Bignami E, Biondi-Zoccai G, Landoni G, Fochi O, Testa V, Sheiban I, Giunta F, Zangrillo A. Volatile anesthetics reduce mortality in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(5): 594–9. doi: 10.1053/j.jvca.2009.01.022.
37. Jakobsen CJ, Berg H, Hindsholm KB, Faddy N, Sloth E. The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures. J Cardiothorac Vasc Anesth. 2007;21(5): 664–71. doi: 10.1053/j.jvca.2007.03.002.
38. Landoni G, Greco T, Biondi-Zoccai G, Nigro Neto C, Febres D, Pintaudi M, Pasin L, Cabrini L, Finco G, Zangrillo A. Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. Br J Anaesth. 2013;111(6): 886–96. doi: 10.1093/bja/aet231.
39. De Hert S, Vlasselaers D, Barbé R, Ory JP, Dekegel D, Donnadonni R, Demeere JL, Mulier J, Wouters P. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia. 2009;64(9): 953–60. doi: 10.1111/j.1365-2044.2009.06008.x.
40. Likhvantsev VV, Landoni G, Levikov DI, Grebenchikov OA, Skripkin YV, Cherpakov RA. Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial. J Cardiothorac Vasc Anesth. 2016;30(5): 1221–7. doi: 10.1053/j.jvca.2016.02.030.
41. Landoni G, Augoustides JG, Guarracino F, Santini F, Ponschab M, Pasero D, Rodseth RN, Biondi- Zoccai G, Silvay G, Salvi L, Camporesi E, Comis M, Conte M, Bevilacqua S, Cabrini L, Cariello C, Caramelli F, De Santis V, Del Sarto P, Dini D, Forti A, Galdieri N, Giordano G, Gottin L, Greco M, Maglioni E, Mantovani L, Manzato A, Meli M, Paternoster G, Pittarello D, Rana NK, Ruggeri L, Salandin V, Sangalli F, Zambon M, Zucchetti M, Bignami E, Alfieri O, Zangrillo A. Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(1): 9–19.
