Effect of anesthetic choice on ST-segment-defined myocardial ischemia and early postoperative course in monopolar TURP

Objective: This historical cohort, originally collected as a prospective, randomized study was re-analyzed to compare propofol–remifentanil–based intravenous anesthesia (P‑RIA) and sevoflurane‑based balanced anesthesia (BA) regarding ST‑segment–defined myocardial ischemia and hemodynamic stability in elderly ASA II–III patients with cardiovascular comorbidities undergoing monopolar transurethral resection of the prostate (TURP). As troponin measurements were unavailable, myocardial injury after non‑cardiac surgery (MINS) was considered only as a conceptual framework rather than a predefined endpoint.Methods: Sixty‑six patients scheduled for elective monopolar TURP (n = 33 per group) were randomized in a single‑center, outcome‑assessor‑blinded design to receive P‑RIA or BA. Continuous ST‑segment monitoring (leads DII, V5, aVL) was performed from 15 minutes before induction to 15 minutes postoperatively. ECGs were read by a blinded cardiologist, and hemodynamics, electrolytes, and CK‑MB/CK were recorded serially.Results: Baseline demographic and surgical characteristics, as well as overall ischemia incidence and duration, were similar between groups. Blood pressure and heart rate were lower and more stable with P‑RIA. At 15 minutes postoperatively, ischemia was less frequent in the P‑RIA group than in the BA group (15.2% vs 36.4%; p = 0.045), an exploratory finding. CK‑MB levels, CK‑MB/CK ratios, electrolyte values, and postoperative complications did not differ significantly.Conclusion: In this elderly, comorbid TURP cohort, P‑RIA was associated with a more stable hemodynamic profile and a transiently lower early postoperative ischemia rate, without reducing total perioperative ischemic burden or CK‑MB–based myocardial injury. The data are hypothesis‑generating and require confirmation in larger troponin‑based MINS studies.