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Effect of sevoflurane on the ex vivo secretion of TNF‐&agr; during and after coronary artery bypass surgery

Background and objective: Sevoflurane has been used for the induction and maintenance of anaesthesia during cardiac surgery owing to its favourable haemodynamic effects. It has been suggested that it offers protection against myocardial ischaemia‐reperfusion injury. Methods: We investigated the effect of sevoflurane on plasma concentrations of tumour necrosis factor‐&agr; (TNF‐&agr;) after ex vivo stimulation of whole‐blood leukocytes by lipopolysaccharide from 20 patients undergoing coronary artery bypass surgery. The patients were randomized to two groups. Group 1 patients were induced and maintained with sevoflurane; those in Group 2 were anaesthetized with moderate doses of midazolam‐sufentanil. Blood samples were drawn from the patients on seven occasions from before induction of anaesthesia until 24 h after skin closure. Results: Plasma concentrations of TNF‐&agr; were lower in Group 1 than in Group 2 after cessation of cardiopulmonary bypass (median (interquartiles): 25 (21‐30) versus 37 (28‐79) pg mL−1; P < 0.05) and 24 h after skin closure (196 (100‐355) versus 382 (233‐718) pgmL−1; P < 0.05). Postoperatively, two cases of myocardial infarction were recorded, one in each group. Six patients in Group 2 needed continued inotropic support after the first morning to maintain haemodynamic stability versus one patient in Group 1 (P < 0.05). The length of stay in the intensive care unit was significantly lower in Group 1 than in Group 2 (mean ± SD: 25 ± 16 versus 54 ± 30 h; P < 0.05). Conclusions: Sevoflurane reduces production of TNF‐&agr; more than total intravenous anaesthesia with midazolam‐sufentanil during cardiac surgery. This may reduce cardiac morbidity and the length of stay in the intensive care unit.