Desflurane vs. Propofol for Cardiac Anesthesia

Condition(s) studied

Investigational drug(s) / intervention(s)

Desflurane group: After routine induction, maintain anesthesia with inhaled desflurane , adjusting concentration as needed to sustain 0.5-2 MAC . To maximize the cardioprotective effects of inhaled anesthetics, adhere to this intraoperative strategy: Maintain ≥1 MAC continuous desflurane for ≥30 minutes ; For on-pump CABG , discontinue desflurane 15 minutes before initiating cardiopulmonary bypass (CPB) ; If intraoperative desflurane cessation is required, implement a wash-in/wash-out strategy (recommended but non-mandatory): Perform 3 alternating cycles of: Wash-in : ≥10 minutes of desflurane at ≥0.5 MAC, Wash-out : ≥10 minutes of complete cessation of inhaled anesthetics. Propofol is strictly prohibited for anesthesia maintenance throughout the procedure , except during CPB.

Propofol group: Administer total intravenous anesthesia (TIVA) using propofol infusion at 3-8 mg/kg/h . No inhaled anesthetics are permitted for maintenance. This may be delivered via:target-controlled infusion (TCI) systems, or manual adjustment of intravenous infusion rates.

Study summary

To investigate whether the inhaled anesthetic desflurane, compared with propofol, exerts cardioprotective effects and reduces the incidence of severe postoperative major cardiac events in patients undergoing coronary artery bypass graft (CABG) surgery.

Eligibility

Primary outcome measure(s)

• Composite outcome of death and major cardiac events — within 30 days after operation
  It is composite outcome including: 1. All-cause mortality within 30 days postoperatively 2. New-onset acute heart failure, or any of the following: Cardiac arrest with successful resuscitation; Cardiogenic shock requiring mechanical circulatory support: Intra-aortic balloon pump (IABP), Extracorporeal membrane oxygenation (ECMO), Left ventricular assist device (e.g., Impella); Low cardiac output syndrome necessitating high-dose inotropic support (Inotropic Score (IS) \>15 within the first 24 postoperative hours, IS \>10 within 48 postoperative hours). 3. Arrhythmia requiring intervention: New-onset atrial fibrillation (pharmacotherapy or pacemaker),Other clinically significant arrhythmias. 4. Acute myocardial infarction 5. Emergency sternotomy/re-exploration for: Cardiac tamponade, Uncontrolled hemorrhage, Other life-threatening complications.

Trial sites (14)