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All patients undergoing cardiac surgery require intraoperative anesthesia and short-term postoperative sedation with anesthetic agents after the procedure when patient is in the intensive care unit (ICU). The clinical data obtained so far are concentrating on intraoperative use volatile agents (preconditioning) resulting in better postoperative cardiac function and less release of biochemical markers of myocardial damage. There are no studies investigating whether postoperative use of volatile agents (post conditioning) in cardiac surgical population is improving outcomes. The aim of the present study is to compare total intravenous anesthesia and postoperative sedation versus total volatile anesthesia and postoperative sedation in cardiac surgical population.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PA-Intravenous Sedation | Active Comparator | Propofol based total intravenous anesthesia and postoperative sedation |
|
| Volatile sedation | Active Comparator | Total inhalational anesthesia and postoperative sedation with the AnaConda device |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Isoflurane/sevoflurane | Drug | Volatile for sedation in the CVICU while intubated |
|
| Measure | Description | Time Frame |
|---|---|---|
| The composite primary end point of the trial will be the development of enzymatic signs of myocardial injury or MI, postoperative low output syndrome, or both. Enzymatic MI will be determined after obtaining serial measurements of troponin. | Measurements of troponin levels will be after induction of anesthesia (baseline) and at 0, 2, 4, 8, and 24 h after arrival into the ICU. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of sedation | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) | |
| Incidence of delirium | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
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Inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marcin Wasowicz, MD | Toronto General Hospital, University Health Network | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Toronto General Hopsital | Toronto | Ontario | M5G 2C4 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29913033 | Derived | Wasowicz M, Jerath A, Luksun W, Sharma V, Mitsakakis N, Meineri M, Katznelson R, Yau T, Rao V, Beattie WS. Comparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study. Anaesthesiol Intensive Ther. 2018;50(3):200-209. doi: 10.5603/AIT.a2018.0012. Epub 2018 Jun 18. | |
| 23132045 |
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| ID | Term |
|---|---|
| D007530 | Isoflurane |
| D000077149 | Sevoflurane |
| D015742 | Propofol |
| ID | Term |
|---|---|
| D008738 | Methyl Ethers |
| D004987 | Ethers |
| D009930 | Organic Chemicals |
| D006845 | Hydrocarbons, Fluorinated |
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| Propofol | Other | Propofol for sedation in the CVICU |
|
|
| Time to readiness for extubation, time to extubation | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
| Length of stay within ICU, readiness for discharge from the unit | Post ICU arrival POD 0 to discharge (2hours to on average 5-7 days until discharge) |
| Pickworth T, Jerath A, DeVine R, Kherani N, Wasowicz M. The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report. Can J Anaesth. 2013 Jan;60(1):38-43. doi: 10.1007/s12630-012-9814-5. Epub 2012 Nov 7. |
| D006846 |
| Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |