USPOREDBA INTRAVENSKIH I VOLATILNIH ANESTETIKA ZA OPERACIJE NA SRCU

Cardiovascular diseases are the leading cause of death and disability in the world and are the most important reason for hospital treatment. They can be successfully controlled by pharmacological theraphy, but can often result in the need for surgery. The most common heart surgery in adulthood is coronary artery bypass graft surgery. The goal of surgery is to reduce the symptoms and risk of recurrence of heart attack and improve patient survival. The type of anesthesia used in cardiac surgery is general anesthesia and is achieved by the use of volatile and intravenous anesthetics – most often a combination of them (balanced anesthesia). Propofol is an intravenous anesthetic that is often used for its rapid onset of action and rapid elimination, the ability to precisely control sedation and cardioprotection in heart surgery. In addition to being used for induction and maintenance of anesthesia, it is also suitable in the postoperative period for the purpose of sedation. Volatile anesthetics are most commonly used in the maintenance phase of anesthesia. Sevoflurane, desflurane and isoflurane showed significant cardioprotective effects, reducing the incidence of myocardial ischemia during surgery but also in the postoperative period. These two groups differ in the mechanism by which myocardial protection is achieved; while volatile anesthetics act on a principle similar to ischemic preconditioning, propofol reduces oxidative stress after ischemic – reperfusion injury. Significant differences in reduced postoperative mortality, shorter hospital stays, effects on hemodynamics and late complications have not been fully demonstrated, but volatile anesthetics have been recognized to provide better surgical outcome in low – risk patients with stable angina pectoris without recent myocardial infarction and ejection fraction larger than 55% while intravenous anesthetics are a better choice in high – risk patients with unstable angina, recent infarction and low ejection fraction.