Volatile Anesthetics versus Propofol for Myocardial Protection in Cardiac Surgery

Abstract

Introduction: Volatile anesthetics have shown cardioprotective effects through preconditioning mechanisms. This review compares volatile-based versus propofol-based anesthesia for myocardial injury and clinical outcomes after cardiac surgery.

Methods: A systematic review and meta-analysis of randomized trials comparing sevoflurane or desflurane with propofol in adults undergoing coronary artery bypass grafting or valve surgery. Primary outcome was postoperative troponin release. Secondary outcomes included inotropic support duration and 30-day mortality.

Results: Sixteen trials (2,203 patients) were included. Volatile anesthetics reduced peak troponin I by 1.4 ng/mL compared to propofol. Duration of inotropic support was shorter by 6 hours in the volatile group. No mortality difference was observed. Postoperative renal function and ICU length of stay were similar between groups.

Discussion: The cardioprotective effect of volatiles is attributed to activation of mitochondrial adenosine triphosphate-sensitive potassium channels and reduction of reperfusion injury. The lack of mortality benefit may reflect that most trials excluded high-risk patients with severe left ventricular dysfunction. Trials varied in volatile agent choice and whether propofol was used for maintenance or only for sedation after cardiopulmonary bypass.

Conclusions: Volatile anesthetics reduce myocardial injury biomarkers compared to propofol in cardiac surgery but do not clearly lower mortality. The choice may be guided by institutional resources and avoidance of malignant hyperthermia triggers.