***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 
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    ***EXAMPLES*** 
    Input: Background The present study investigated the effects of propofol , desflurane , and sevoflurane on recovery of myocardial function in high-risk coronary surgery patients . High-risk patients were defined as those older than 70 yr with three-vessel disease and an ejection fraction less than 50 % with impaired length-dependent regulation of myocardial function . Methods Coronary surgery patients ( n = 45 ) were r and omly assigned to receive either target-controlled infusion of propofol or inhalational anesthesia with desflurane or sevoflurane . Cardiac function was assessed perioperatively and during 24 h postoperatively using a Swan-Ganz catheter . Perioperatively , a high-fidelity pressure catheter was positioned in the left and right atrium and ventricle . Response to increased cardiac load , obtained by leg elevation , was assessed before and after cardiopulmonary bypass ( CPB ) . Effects on contraction were evaluated by analysis of changes in dP/dtmax . Effects on relaxation were assessed by analysis of the load-dependence of myocardial relaxation . Postoperative levels of cardiac troponin I were followed for 36 h. Results After CPB , cardiac index and dP/dtmax were significantly lower in patients under propofol anesthesia . Post-CPB , leg elevation result ed in a significantly greater decrease in dP/dtmax in the propofol group , whereas the responses in the desflurane and sevoflurane groups were comparable with the responses before CPB . After CPB , load dependence of left ventricular pressure drop was significantly higher in the propofol group than in the desflurane and sevoflurane group . Troponin I levels were significantly higher in the propofol group . Conclusions Sevoflurane and desflurane but not propofol preserved left ventricular function after CPB in high-risk coronary surgery patients with less evidence of myocardial damage postoperatively BACKGROUND Whether remote ischemic preconditioning ( transient ischemia and reperfusion of the arm ) can improve clinical outcomes in patients undergoing coronary-artery bypass graft ( CABG ) surgery is not known . We investigated this question in a r and omized trial . METHODS We conducted a multicenter , sham-controlled trial involving adults at increased surgical risk who were undergoing on-pump CABG ( with or without valve surgery ) with blood cardioplegia .  After anesthesia induction and before surgical incision , patients were r and omly assigned to remote ischemic preconditioning ( four 5-minute inflations and deflations of a st and ard blood-pressure cuff on the upper arm ) or sham conditioning ( control group ) . Anesthetic management and perioperative care were not st and ardized . The combined primary end point was death from cardiovascular causes , nonfatal myocardial infa rct ion , coronary revascularization , or stroke , assessed 12 months after r and omization . RESULTS We enrolled a total of 1612 patients ( 811 in the control group and 801 in the ischemic-preconditioning group ) at 30 cardiac surgery centers in the United Kingdom . There was no significant difference in the cumulative incidence of the primary end point at 12 months between the patients in the remote ischemic preconditioning group and those in the control group ( 212 patients [ 26.5 % ] and 225 patients [ 27.7 % ] , respectively ; hazard ratio with ischemic preconditioning , 0.95 ; 95 % confidence interval , 0.79 to 1.15 ; P=0.58 ) . Furthermore , there were no significant between-group differences in either adverse events or the secondary end points of perioperative myocardial injury ( assessed on the basis of the area under the curve for the high-sensitivity assay of serum troponin T at 72 hours ) , inotrope score ( calculated from the maximum dose of the individual inotropic agents administered in the first 3 days after surgery ) , acute kidney injury , duration of stay in the intensive care unit and hospital , distance on the 6-minute walk test , and quality of life . CONCLUSIONS Remote ischemic preconditioning did not improve clinical outcomes in patients undergoing elective on-pump CABG with or without valve surgery . ( Funded by the Efficacy and Mechanism Evaluation Program [ a Medical Research Council and National Institute of Health Research partnership ] and the British Heart Foundation ; ERICCA Clinical Trials.gov number , NCT01247545 . ) BACKGROUND Remote ischemic preconditioning ( RIPC ) is reported to reduce biomarkers of ischemic and reperfusion injury in patients undergoing cardiac surgery , but uncertainty about clinical outcomes remains . METHODS We conducted a prospect i ve , double-blind , multicenter , r and omized , controlled trial involving adults who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass under total anesthesia with intravenous propofol .  The trial compared upper-limb RIPC with a sham intervention . The primary end point was a composite of death , myocardial infa rct ion , stroke , or acute renal failure up to the time of hospital discharge . Secondary end points included the occurrence of any individual component of the primary end point by day 90 . RESULTS A total of 1403 patients underwent r and omization . The full analysis set comprised 1385 patients ( 692 in the RIPC group and 693 in the sham-RIPC group ) . There was no significant between-group difference in the rate of the composite primary end point ( 99 patients [ 14.3 % ] in the RIPC group and 101 [ 14.6 % ] in the sham-RIPC group , P=0.89 ) or of any of the individual components : death ( 9 patients [ 1.3 % ] and 4 [ 0.6 % ] , respectively ; P=0.21 ) , myocardial infa rct ion ( 47 [ 6.8 % ] and 63 [ 9.1 % ] , P=0.12 ) , stroke ( 14 [ 2.0 % ] and 15 [ 2.2 % ] , P=0.79 ) , and acute renal failure ( 42 [ 6.1 % ] and 35 [ 5.1 % ] , P=0.45 ) . The results were similar in the per- protocol analysis . No treatment effect was found in any subgroup analysis . No significant differences between the RIPC group and the sham-RIPC group were seen in the level of troponin release , the duration of mechanical ventilation , the length of stay in the intensive care unit or the hospital , new onset of atrial fibrillation , and the incidence of postoperative delirium . No  RIPC-related adverse events were observed . CONCLUSIONS Upper-limb RIPC performed while patients were under propofol-induced anesthesia did not show a relevant benefit among patients undergoing elective cardiac surgery . ( Funded by the German Research Foundation ; RIPHeart Clinical Trials.gov number , NCT01067703 . ) Background : Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion . In clinical studies , the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period . The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration . Methods : Elective coronary surgery patients were r and omly assigned to four different anesthetic protocol s ( n = 50 each ) . In a first group , patients received a propofol based intravenous regimen ( propofol group ) . In a second group , propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass ( SEVO pre group ) . In a third group , propofol was replaced by sevoflurane after completion of the coronary anastomoses ( SEVO post group ) . In a fourth group , propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation ( SEVO all group ) . Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively . Results : Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group . Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group . In the SEVO pre and SEVO post groups , stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group . Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group . Conclusion : In patients undergoing coronary artery surgery with cardiopulmonary bypass , the cardioprotective effects of sevoflurane were clinical ly most apparent when it was administered throughout the operation OBJECTIVE Minimally invasive mitral valve repair may be associated with prolonged cardioplegic arrest times and ischemic reperfusion injury . Intravenous ( propofol ) and volatile ( sevoflurane ) anesthesia are used routinely during cardiac surgery and are thought to provide cardioprotection ; however , the individual contribution of each regimen to cardioprotection is unknown . Therefore , the authors sought to compare the cardioprotective effects of propofol and sevoflurane anesthesia in patients undergoing minimally invasive mitral valve repair . DESIGN A single-center single-blind r and omized controlled trial . SETTING A specialized regional cardiac surgery center in Italy . PARTICIPANTS The study enrolled 62 adults undergoing elective isolated minimally invasive mitral valve repair for degenerative disease . Exclusion criteria included secondary mitral regurgitation , previously treated coronary artery disease , diabetes mellitus , chronic renal failure requiring dialysis , atrial fibrillation , and documented allergy to either propofol or sevoflurane . INTERVENTIONS All patients received video-assisted minimally invasive right minithoracotomy . Patients were r and omized to receive propofol or sevoflurane anesthesia in a 1:1 ratio . MEASUREMENTS AND MAIN RESULTS Cardiac troponin I release was measured over the first 72 hours postoperatively . Operative , cross-clamp , and total bypass times were similar between groups . Cardiac troponin I release was reduced nonsignificantly in the propofol group ( p = 0.62 ) , and peak troponin I release was correlated with cross-clamp time in both groups . There were no differences in terms of intraoperative lactate release and blood pH between groups . CONCLUSION Propofol and sevoflurane anesthesia were associated with similar degrees of myocardial injury , indicating comparable cardioprotection . Myocardial injury was related directly to the duration of cardioplegic arrest Background Sevoflurane has been shown to protect against myocardial ischemia and reperfusion injury in animals . The present study investigated whether these effects were clinical ly relevant and would protect left ventricular ( LV ) function during coronary surgery . Methods Twenty coronary surgery patients were r and omly assigned to receive either target-controlled infusion of propofol or inhalational anesthesia with sevoflurane . Except for this , anesthetic and surgical management was the same in all patients . A high-fidelity pressure catheter was positioned in the left ventricle and the left atrium . LV response to increased cardiac load , obtained by leg elevation , was assessed before and after cardiopulmonary bypass ( CPB ) . Effects on contraction were evaluated by analysis of changes in dP/dtmax . Effects on relaxation were assessed by analysis of the load dependence of myocardial relaxation ( R = slope of the relation between time constant & tgr ; of isovolumic relaxation and end-systolic pressure ) . Postoperative concentrations of cardiac troponin I were followed during 36 h. Results Before CPB , leg elevation slightly increased dP/dtmax in the sevoflurane group ( 5 ± 3 % ) , whereas it remained unchanged in the propofol group ( 1 ± 6 % ) . After CPB , leg elevation result ed in a decrease in dP/dtmax in the propofol group ( −5 ± 4 % ) , whereas the response in the sevoflurane group was comparable to the response before CPB ( 5 ± 4 % ) . Load dependence of LV pressure fall ( R ) was similar in both groups before CPB . After CPB , R was increased in the propofol group but not in the sevoflurane group . Troponin I concentrations were significantly lower in the sevoflurane than in the propofol group . Conclusions Sevoflurane preserved LV function after CPB with less evidence of myocardial damage in the first 36 h postoperatively . These data suggest a cardioprotective effect of sevoflurane during coronary artery surgery OBJECTIVE The purpose of this study was to compare the effects of a total intravenous and a volatile anesthetic regimen on biochemical markers of hepatic and renal dysfunction after coronary artery surgery . DESIGN Prospect i ve , double-blind , r and omized clinical study . SETTING University hospital , single institutional . PARTICIPANTS Three hundred twenty patients undergoing elective coronary artery surgery were divided into 2 different anesthetic protocol s : propofol group ( n = 160 ) and sevoflurane group ( n = 160 ) . INTERVENTIONS Hemodynamic  data were registered before the start of surgery , before the start of CP 
    Output:
    
Conclusions : In adults undergoing cardiac surgery with cardiopulmonary bypass , the class of volatile anesthetics was superior to propofol with regard to long-term mortality , as well as to many secondary outcomes indicating myocardial protection .
Although early postoperative mortality did not differ significantly between the anesthetic groups , 1-yr mortality was significantly lower in the patients who received volatile anesthetics .
Additionally patients in the volatile anesthetic group had significantly lower occurrence of perioperative myocardial infa rct ion and troponin release and had higher postoperative cardiac index .