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Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100ß protein levels

[L’anesthésie au propofol, comparé à l’isoflurane, n’a pas d’avantage pour la protection cérébrale pendant la circulation extracorporelle : une étude préliminaire des niveaux de protéines S-100ß]

Meral Kanbak, MD^*, Fatma Saricaoglu, MD^*, Alev Avci, MD^*, Turgay Ocal, MD^*, Zehra Koray and Ulku Aypar, MD^*

^* From the Departments of Anesthesiology and Reanimation, and
the Nuclear Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Address correspondence to: Dr. Meral Kanbak, Department of Anesthesiology and Reanimation, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey. Phone: 90 312 3051987; Fax: 90 312 3109600; E-mail: orhankan{at}ttnet.net.tr

Purpose: Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100ß protein and neuropsychological tests after coronary artery bypass grafting (CABG).

Methods: Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group P. Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100ß protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24^th hr postoperatively (T5).

Results: Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P, S-100ß protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05).

Conclusions: Despite reports about the neuroprotective effects of propofol, S-100ß protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.

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