Optimierung Der Kardioprotektion Durch Inhalative Anästhetika Eine Untersuchung Bei Patienten Mit Diabetes Mellitus während Off-pump Herzchirurgie
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 2
- 试验地点
- 1
- 主要终点
- Biomarker NT-proBNP
研究概览
简要总结
This study evaluates the myocardial protection against perioperative ischemia comparing two standard anesthetic regimes in diabetic patients undergoing elective cardiac surgery. Half of the patients will receive volatile anesthesia while the other half will receive total intravenous anesthesia. Primary and secondary outcome parameters will be assessed after induction of anesthesia, at the end of the procedure and postoperative day 1 to 3.
详细描述
Volatile anaesthetics such as Sevoflurane have shown to have a protective effect regarding myocardial ischemia in the perioperative setting - the so-called "preconditioning". However the observed response of preconditioning in clinical trials is not consistent.
An increased perioperative insulin resistance especially in diabetic patients resulting in an increased postoperative morbidity and mortality may be responsible for these findings.
In an animal model, the use of propofol that is being routinely applied for general anesthesia was associated with a change of the insulin receptor substrate via phosphorylation and thus a change of insulin resistance.
Avoiding a total intravenous anesthesia and applying a volatile anesthesia may result in an increased cardioprotective effect by a reduction of the perioperative insulin resistance.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 40 Years 至 85 Years（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Elective cardiac surgery
排除标准
- •Emergency procedures
- •Preop myocardial infarction
- •Preop cardiac failure
- •Preop renal replacement therapy
研究组 & 干预措施
Sevoflurane
Volatile anesthesia for elective cardiac surgery
干预措施: Sevoflurane (Drug)
Propofol
Total intravenous anesthesia for elective cardiac surgery
干预措施: Propofol (Drug)
结局指标
主要结局
Biomarker NT-proBNP
时间窗: 1. after induction of anesthesia 2. after chest closure 3.-5. postoperative day 1, day 2, day 3
Difference between volatile anesthesia and total intravenous anesthesia
次要结局
- Expression of TNF/IL1beta and microRNA (miR144, miR125b, miR208a)(1. beginning of cardiac surgery, 2. end of cardiac surgery)
- Receptor Substrate phosphorylization (IRS-1)/PP2A(1. beginning of cardiac surgery, 2. end of cardiac surgery)
研究者
Christoph K Hofer
Prof. Dr. med.
Triemli Hospital