DOI: 10.36347/sjams.2014.v02i03.064

Pages: 1182-1189

Background: On-pump cardiac surgery using cardiopulmonary bypass (CPB) subjects the myocardium to ischemia-reperfusion injury, necessitating effective anesthetic cardioprotection. The choice between inhalational anesthesia (IHA) and total intravenous anesthesia (TIVA) may influence myocardial outcomes and postoperative recovery. Objective: To compare myocardial protection efficacy, hemodynamic stability, inflammatory response, and early postoperative outcomes between IHA (sevoflurane-based) and TIVA (propofol-based) in patients undergoing elective on-pump cardiac surgery. Methods: A prospective comparative observational study was conducted at the Department of Cardiothoracic and Vascular Surgery, Kasturba Medical College, Manipal, Karnataka from July 2013 to February 2014. Thirty adult patients undergoing elective on-pump cardiac surgery were enrolled and allocated into two groups of 15 each: the IHA group (sevoflurane maintenance) and the TIVA group (propofol-based maintenance). Primary outcomes included serum cardiac biomarkers (Troponin I, CK-MB), hemodynamic parameters, inflammatory cytokines (IL-6, TNF-alpha), ICU stay, ventilation time, and 30-day mortality. Results: The IHA group demonstrated significantly lower postoperative Troponin I (1.43 ± 0.61 vs. 2.18 ± 0.84 ng/mL; p=0.031), CK-MB (48.6 ± 9.3 vs. 68.4 ± 12.7 U/L; p=0.024), and inflammatory markers (IL-6 at 6h: 96.7 ± 24.1 vs. 148.3 ± 32.6 pg/mL; p=0.021) compared to the TIVA group. ICU stay (28.2 ± 8.1 vs. 38.6 ± 10.4 hours; p=0.018) and mechanical ventilation time (9.7 ± 3.2 vs. 14.3 ± 4.8 hours; p=0.022) were significantly shorter in the IHA group. Conclusion: Sevoflurane-based inhalational anesthesia offers superior myocardial protection and attenuated inflammatory response compared to propofol-based TIVA in elective on-pump cardiac surgery, translating into improved early clinical outcomes. These findings support preferential use of IHA in selected cardiac surgical patients, though larger randomize