Sevoflurane in Intraoperative and Postoperative Cardiac Surgery Patients. Our Experience in Intensive Care Unit with Sevoflurane Sedation

Recently, many studies have shown a decrease in myocardial damage in patients undergoing coronary artery bypass surgery where the anesthetic agent used was sevoflurane compared with propofol. The basis for this protective effect of the myocardium occurs through the mechanisms of preconditioning and postconditioning of halogenated agents. Both relate to the benefit of prior or subsequent administration of the drug (halogenated anesthetic agent) to the harmful stimulus for myocardial cells. The two mechanisms have similar effector mechanisms. The intraoperative administration of sevoflurane is common in anesthetic practice, but the continuation of the administration in the first postoperative hours is made possible by the AnaConDa ® device (ACD; Sedana Medical AB, Uppsala, Sweden) designed for halogenated sedation of patients admitted to intensive care units (ICU). This device has proven useful to facilitate the treatment of pathological conditions. The object of our review is to determine if there are beneficial effects to extending exposure to halogenated agents in the immediate post-operative period . In the post-operative phase, the pathological myocardium is in a reperfusion process in the coronary microcirculation and expression of certain receptors and chemical mediators can reduce potential injury secondary to reperfusion of previously hibernating and/or stunned tissue