A Review of the Effect of Sevoflurane Versus Propofol for Maintenance of General Anesthesia during Cardiopulmonary Bypass

Bahare  Firouzbakht; Bahareh  Hakiminia; Laleh  Dehghanpisheh

doi:10.18502/aacc.v11i5.19938

Bahare Firouzbakht Department of Anesthesiology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Bahareh Hakiminia Department of Clinical Pharmacy, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran.
Laleh Dehghanpisheh Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

DOI: https://doi.org/10.18502/aacc.v11i5.19938

Keywords: Cardiac surgical procedures; Cardiopulmonary bypass; Cognitive dysfunction; Inflammation; Sevoflurane

Abstract

Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB.

Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024.

Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea.

Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue.