Desflurane vs. Propofol for Cardiac Anesthesia
Desflurane vs. Propofol for Cardiac Anesthesia: Impact on Developing Major Cardiac Events in Patients Undergoing CABG Procedure
Xijing Hospital
3,560 participants
Oct 20, 2025
INTERVENTIONAL
Conditions
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
Inclusion Criteria3
- Patients scheduled for elective coronary artery bypass grafting (CABG)
- Age ≥ 18 years old;
- Sign the informed consent form.
Exclusion Criteria12
- Emergency or urgent operation
- Concomitant valve or aortic surgery
- History of myocardial infarction in recent 30 days
- Current use of myocardial preconditioning-affecting medications, such as sulfonylurea (glibenclamide), allopurinol, theophylline, nicorandil(last dose \< 8 hrs), etc
- Participated in other randomized controlled clinical trials in recent 3 months
- General anesthesia in recent 30 days
- History of kidney and liver transplantation, or severe liver and kidney dysfunction (EGFR ≤ 20 mlgmin/1.73 m2, conventional dialysis or patients who have started dialysis; Child Pugh grade C/cirrhosis)
- History of open heart surgery;
- Hemodynamic instability or severe heart failure (SBP\<90 mmHg or preoperative need of high-dose vasoactive drug support, placement of aortic balloon pump (IABP), ECMO or ventricular assist device, left ventricular ejection fraction\<30%)
- Adverse drug reactions to trial medications
- History of malignant hyperthermia
- Pregnancy or lactation
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Interventions
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.
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.
Locations(14)
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NCT07116733