***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Cardiopulmonary bypass ( CPB ) contributes to the secretion of anti-inflammatory cytokines that mediate the inflammatory response observed during open heart surgery . In addition to many factors , type of anesthesia management affects immune response and central nervous system in cardiac surgery . The aim of this study was to assess the effect of propofol versus desflurane anesthesia on systemic immune modulation and central nervous system on patients undergoing coronary artery bypass grafting . Forty patients undergoing elective coronary artery bypass graft surgery with CPB were included in this prospect i ve r and omized study . Patients were allocated to receive propofol ( n = 20 ) or desflurane ( n = 20 ) for maintenance of anesthesia . The blood sample s for IL-6 , IL-8 , TNF-α , and S100β were drawn just prior to the operation before the induction of anesthesia , second before cardiopulmonary bypass , third after CPB , fourth 4 h postoperatively at the ICU . Major finding in our study is that S100β levels were lower in propofol group when compared to desflurane anesthesia . And also immune reaction was less in patients exposed to desflurane anesthesia when compared to propofol anesthesia as indicated by lower plasma concentrations of IL-8 and IL-6 . Propofol is more preferable in terms of S100β for anesthetic management for CABG OBJECTIVES Neuropsychological disorders are some of the most common complications of coronary artery bypass graft ( CABG ) surgery . The early diagnosis of postoperative brain damage is difficult and mainly based on the observation of specific brain injury markers . The aim of this study was to analyze the effects of volatile anesthesia ( VA ) on plasma total and ionized arteriovenous magnesium concentrations in the brain circulation ( a-vtMg and a-viMg ) , plasma matrix metalloproteinase-9 ( MMP-9 ) , and glial fibrillary acidic protein ( GFAP ) in adult patients undergoing CABG surgery . DESIGN An observational study . SETTING The Department of Cardiac Surgery in a Medical University Hospital . PATIENTS AND METHODS Studied parameters were measured during surgery and in the early postoperative period . Patients were assigned to 3 groups : group O , patients who did not receive VA ; group ISO , patients who received isoflurane ; and group SEV , patients who received sevoflurane . RESULTS Ninety-two patients were examined . CABG surgery increased MMP-9 and GFAP . The highest MMP-9 , GFAP , and the most dramatic disorders in a-vtMg and a-viMg were noted in group O. CONCLUSIONS Cardiac surgery increased plasma MMP-9 and GFAP concentrations . Changes in MMP-9 , GFAP , and arteriovenous tMg and iMg were significantly higher in group O. Volatile anesthetics , such as ISO or SEV , reduced plasma MMP-9 , GFAP concentrations , and disturbances in a-vtMg and a-viMg We investigated the long-term effects of sevoflurane on histopathologic injury and key proteins of apoptosis in a rat hemispheric ischemia/reperfusion model . Sixty-four male Sprague-Dawley rats were r and omly assigned to Group 1 ( fentanyl and N2O/O2 ; control ) and Group 2 ( 2.0 vol% sevoflurane and O2/air ) . Ischemia ( 45 min ) was produced by unilateral common carotid artery occlusion plus hemorrhagic hypotension ( mean arterial blood pressure 40 mm Hg ) . Animals were killed after 1 , 3 , 7 , and 28 days . In hematoxylin and eosin-stained brain sections eosinophilic hippocampal neurons were counted . Activated caspase-3 and the apoptosis-regulating proteins Bax , Bcl-2 , Mdm-2 , and p53 were analyzed by immunostaining . No eosinophilic neurons were detected in sevoflurane-anesthetized rats over time , whereas 9%–38 % of the hippocampal neurons were eosinophilic ( days 1–28 ) in control animals . On days 1 and 3 , the concentration of Bax was 140%–200 % larger in fentanyl/N2O-anesthetized animals compared with sevoflurane . Bcl-2 was 100 % less in control animals during the first 3 days . Activated caspase-3 was detected in neurons of both groups ( 0.75%–2.2 % ) . These data support a sustained neuroprotective potency of sevoflurane related to reduced eosinophilic injury after cerebral ischemia/reperfusion BACKGROUND A recent study demonstrated that almost 75 % of strokes after coronary artery revascularization surgery occur in patients classified preoperatively as low to medium risk . Thus , despite the use of risk classification , most strokes can occur when not expected . We hypothesized that optimization of cerebral oxygen delivery variables by using noninvasive cerebral oximetry could reduce the incidence of stroke . METHODS Cerebral oximetry was used by all surgeons to monitor cerebral oxygen saturation in all cardiac surgery patients from January 1 , 2002 , until June 30 , 2003 ( n = 1034 ; 18 months , treatment group ) .  Cerebral oxygen delivery was optimized during surgery by modifying oxygen delivery and consumption variables to maintain oximetry values at or near the patient 's preinduction baseline . Stroke was defined according to guidelines of the Society of Thoracic Surgeons . The incidence of stroke in the treatment group was compared with that for patients who underwent cardiac surgery between July 1 , 2000 , and December 31 , 2001 , ( n = 1245 ; 18 months , control group ) before cerebral oximetry was incorporated . RESULTS Age and sex distribution were similar in the 2 groups . The study group had significantly more patients in New York Heart Association ( NYHA ) classes III and IV than the control group , and patients in the study group were sicker overall . Despite this difference , the study group overall had fewer permanent strokes ( 10 [ 0.97 % ] versus 25 [ 2.5 % ] ; P < .044 ) . This difference remained significant when the results were controlled for NYHA class and on-pump or off-pump surgery . When the patients were examined by NYHA class , the proportion of patients requiring prolonged ventilation was significantly smaller in the study group ( 6.8 % versus 10.6 % ; P < .0014 ) , as was the length of hospital stay ( P < .046 ) . CONCLUSIONS The treatment group , which underwent all cardiac surgeries with optimized cerebral oxygen delivery using cerebral oximetry monitoring , demonstrated a significantly lower incidence of permanent stroke . Because our study is retrospective , a prospect i ve r and omized trial is warranted BACKGROUND Previously , we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death , myocardial infa rct ion , stroke , or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting ( CABG ) performed with a beating-heart technique ( off-pump )  and those who underwent CABG performed with cardiopulmonary bypass ( on-pump ) . We now report results on quality of life and cognitive function and on clinical outcomes at 1 year . METHODS We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and r and omly assigned them to undergo the procedure off-pump or on-pump . Patients were enrolled at 79 centers in 19 countries . We assessed quality of life and cognitive function at discharge , at 30 days , and at 1 year and clinical outcomes at 1 year . RESULTS At 1 year , there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG ( 12.1 % and 13.3 % , respectively ; hazard ratio with off-pump CABG , 0.91 ; 95 % confidence interval [ CI ] , 0.77 to 1.07 ; P=0.24 ) . The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year ( hazard ratio , 0.79 ; 95 % CI , 0.55 to 1.13 ; P=0.19 ) . The rate of repeat coronary revascularization at 1 year was 1.4 % in the off-pump group and 0.8 % in the on-pump group ( hazard ratio , 1.66 ; 95 % CI , 0.95 to 2.89 ; P=0.07 ) . There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function . CONCLUSIONS At 1 year after CABG , there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome , the rate of repeat coronary revascularization , quality of life , or neurocognitive function . ( Funded by the Canadian Institutes of Health Research ; CORONARY Clinical Trials.gov number , NCT00463294 . ) In this study , we examined the cerebral oxygenation effects of two methods of pharmacologic burst suppression during cardiopulmonary bypass ( CPB ) in valvular heart surgery patients . Patients were r and omly entered into one of three groups : control ( n = 13 , fentanyl and midazolam )  , control plus burst suppression doses of thiopental ( n = 15 ) , or control plus burst suppression doses of isoflurane ( n = 16 ) . Burst suppression ( 80 % suppression ) was accomplished in the thiopental and isoflurane groups 15 min before aortic cannulation and was maintained through aortic decannulation . Cerebral physiologic measurements were made during hypothermia ( 27 - 28[degree sign]C ) and on rewarming to 36[degree sign]C. During hypothermia , burst suppression produced significant ( P < 0.005 ) differences with regard to cerebral vascular resistance ( P = 0.003 ) , cerebral arterial venous oxygen difference [ C(a-v)O2 ] ( P = 0.032 ) , cerebral blood flow ( CBF ) ( P = 0.009 ) , and cerebral oxygen delivery ( P = 0.027 ) . There was a similar pattern on rewarming , with groups differing significantly ( P < 0.05 ) with respect to CBF ( P = 0.016 ) , cerebral vascular resistance ( P = 0.008 ) , oxygen delivery ( P = 0.004 ) , C(a-v)O2 ( P = 0.043 ) , and cerebral oxygen extraction ( P = 0.046 ) . Rewarming rates were similar among groups . There was no difference in neurologic outcome or requirement for inotropic support among groups . The time to awakening was increased ( P = 0.0005 ) in the thiopental group . The thiopental group had lower cerebral oxygen delivery , but not lower cerebral metabolic rate of oxygen consumption , compared with the control group , result ing in widening C(a-v)O2 during CPB . This lack of coupling of oxygen delivery and consumption suggests that pharmacologic neuroprotective mechanisms are complex and involve more than an improvement in the ratio of global cerebral oxygen supply to dem and . Implication s : This study demonstrates that the balance of cerebral oxygen delivery to consumption during cardiopulmonary bypass is altered differently by thiopental and isoflurane . As others have noted , it seems that cerebral protection is more complex than a simple improvement in the balance of oxygen delivery and consumption . ( Anesth Analg 1998;86:246 - 51 BACKGROUND Because the time available for cooling and rewarming during deliberate mild hypothermia is limited , studies of the rate of the cooling and rewarming are useful . The decrease in core hypothermia caused by heat redistribution depends on the anaesthetic agent used . We therefore investigated possible differences between sevoflurane and propofol on the decrease and recovery of core temperature during deliberate mild hypothermia for neurosurgery . METHODS After institutional approval and informed consent , 26 patients were assigned r and omly to maintenance of anaesthesia with propofol or sevoflurane .  Patients in the propofol group ( n=13 ) received propofol induction followed by a continuous infusion of propofol 3 - 5 mg kg(-1 ) h(-1 ) . Patients in the  sevoflurane  group ( n=13 ) received propofol induction followed by sevoflurane 1 - 2 % . Nitrous oxide and fentanyl were also used for anaesthetic maintenance . After induction of anaesthesia , patients were cooled and tympanic membrane temperature was maintained at 34.5 degrees C. After surgery , patients were actively rewarmed . RESULTS There was no difference in the rate of decrease and recovery of core temperature between the groups . There was also no difference in skin surface temperature gradient ( forearm to fingertip ) , heart rate and mean arterial blood pressure between the groups . CONCLUSIONS Sevoflurane-based anaesthesia did not affect cooling and rewarming for deliber 
    Output:
    
Among secondary outcome variables , mini-mental state examination scores of the inhalation anaesthesia group were significantly higher than those of the TIVA group 24 hours after operation ( WMD ( 95 % CI ) : 1.87 ( 0.82 to 2.92 ) ) , but no significant difference was found in arteriovenous oxygen content difference , cerebral oxygen extraction ratio and jugular bulb venous oxygen saturation , which were assessed at cooling and rewarming during CPB .
This study demonstrates that anaesthesia with volatile agents appears to provide better cerebral protection than TIVA for patients undergoing cardiac surgery with CPB , suggesting that inhalation anaesthesia may be more suitable for patients undergoing cardiac surgery