Comparison between Propofol and Total Inhalational Anaesthesia on Cardiovascular Outcomes Following On-pump Cardiac Surgery in Higher-Risk Patients – A Randomised Controlled Pilot and Feasibility Study

Abstract

AbstractObjectivesMyocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies, however there is uncertainty as whether this translates into clinical benefits.MethodsIn this single blinded parallel group randomised controlled feasibility trial higher-risk patients undergoing elective coronary artery bypass graft surgery with an additive European System for Cardiac Operative Risk Evaluation (EuroScore)>5 were randomised to receive either propofol or total inhalational anaesthesia for maintenance of anaesthesia. The primary outcome was the feasibility to recruit and randomise 50 patients across two cardiac surgical centres and secondary outcomes included the feasibility of collecting the planned perioperative data and clinically relevant outcomes and assessments of effective patient identification, screening and recruitment.ResultsAll 50 patients were recruited within 11 months in two centres allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up.ConclusionsIt is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates.