Is time to change to halogenated drugs in cardiac surgery, what do we have to do with propofol?

• Published in: Current pharmaceutical design Vol. 20; no. 34; p. 5497
• Main Authors: Landoni, Giovanni, Pasin, Laura, Borghi, Giovanni, Zangrillo, Alberto
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.01.2014
• Subjects: Anesthetics, Inhalation - administration & dosage; Anesthetics, Intravenous - administration & dosage; Animals; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - trends; Cardiotonic Agents - administration & dosage; Clinical Trials as Topic - methods; Humans; Methyl Ethers - administration & dosage; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Propofol - administration & dosage; Sevoflurane; Time Factors
• ISSN: 1873-4286
• DOI: 10.2174/1570161112666140123105536

There is initial evidence, at least in cardiac surgery, that total intra-venous anesthesia (usually a propofol-based total intravenous anesthesia) is associated with an increased mortality when compared to an anesthetic plan including a halogenated anesthetics. The cardiac protective properties of halogenated agents (desflurane, isoflurane and sevoflurane) have not been confirmed in non-cardiac surgery and mixed results exist for patients admitted in postoperative intensive care units. This article summarizes the papers with the most impressive findings in favor of halogenated anesthetics, but it recognizes that, at the same time, there is no evidence based medicine against the use of propofol, highlighting the need for large randomized trials that should focus on survival.