Stenting procedures, cardiac and non-cardiac surgical procedures may carry a significant
risk of cardiac damage ultimately leading to prolonged hospital stay and even a
non-negligible periprocedural mortality rate. According to the American College of
Cardiology/American Heart Association Guidelines all anesthetic techniques and drugs have
known cardiac effects that should be considered in the perioperative plan. There appears
to be no one best myocardium protective anesthetic technique: the choice of anesthesia is
best left to the discretion of the anesthesia care team. To date no anesthesiological
drug or techniques proved to reduce perioperative morbidity and mortality in cardiac
surgery, only Beta-blockers and locoregional analgesia showed improved outcomes after
non-cardiac surgery and no study on anesthesiological drugs has been performed in
stenting procedures.
Volatile anesthetics, which are commonly used in general anesthesia to induce and
maintain hypnosis, analgesia, amnesia and mild muscle relaxation, have been shown to
improve post-ischemic recovery at the cellular level, in isolated hearts, and in animals,
both through a pharmacological preconditioning and postconditioning action. Whether the
cardioprotective effects of volatile anesthetics are clinically applicable and associated
with improved cardiac function, ultimately resulting in a better outcome in patients
undergoing cardiac surgery, is still debated. No data exist on patients undergoing
non-cardiac surgery or stenting procedures.
A recently published meta-analysis including studies considering all volatile anesthetics
showed no reduction in myocardial infarction and perioperative death rate. However the
newer volatile anesthetics (desflurane and sevoflurane) seem to have more prominent
cardioprotective properties and numerous apparently positive reports targeted to
surrogate end-points, yet severely underpowered, have appeared in the literature. Of
interest, many of these studies were not included in the above cited meta-analysis.
To address the question of whether the choice of an anesthetic regimen might influence
patients' outcome we have planned a RCT to determine the impact of sevoflurane on
perioperative cardiac damage in patients undergoing cardiac surgery, non-cardiac surgery
and stenting procedures.
