À propos de cet article
Article Category: Original Paper
Publié en ligne: 31 déc. 2020
Pages: 37 - 42
Reçu: 26 mai 2020
Accepté: 07 août 2020
DOI: https://doi.org/10.2478/rjaic-2020-0017
Mots clés
© 2020 Mihai Stefan, Daniela Filipescu. published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Summary of the outcome studies presented in the article
| First author, year of publication (ref. in the text) | Type of study (number of studies) | Type of surgery (number of patients included) | Intervention | Outcome | Comments |
|---|---|---|---|---|---|
| Meta-analysis of RCTs (22) | Cardiac surgery (1,922) | Either sevoflurane or desflurane vs. TIVA (mainly propofol) | VA decreased the rate of PMI (2.4% vs. 4.1%) and in-hospital mortality (0.4% vs.1.6%) | Different regimens of VA administration | |
| Bayesian network meta- analysis of RCTs (38) | Cardiac surgery (63% on-pump CABG) (3,996) | VA vs. TIVA (mainly propofol) | VAs were associated with: - reduced mortality at the longest available follow-up (1.3% vs.2.6%) (results also confirmed when only low-risk-of-bias stud- ies, larger studies and CABG studies were included) - reduced MV time - reduced ICU and hospital LOS Bayesian network meta-analysis found that sevoflurane and desflurane (but not isoflurane) were associated with mortality reduction | The survival benefit was significant only when aggregating the three volatile agents together | |
| Multicentre RCT | High-risk cardiac surgery (200) | Sevoflurane vs. propofol | No difference in death, prolonged ICU stay, or both No difference in postoperative cTn re- lease, 1-year all-cause mortality, re-hospitalisations and adverse cardiac events | The study was not powered to detect a difference in mortality at 30 days and at 1-year follow-up | |
| Meta-analysis of RCTs (68, 46 in cardiac surgery) | Cardiac and non- cardiac surgery (7,104 -4,840 cardiac surgery patients) | VA vs. TIVA (mainly propofol) | In cardiac surgery, VAs were associated with: - reduced overall mortality (either 30-day, 180-day or 1-year mortality) - reduced rate of pulmonary complications (effect more pronounced with sevoflurane and desflurane) No differences in hospital and ICU LOS | No benefit in non-cardiac surgery | |
| RCT | On-pump elective CABG surgery (868) | Sevoflurane vs. TIVA | Sevoflurane was associated with: - reduced postoperative levels of cTn and NT-proBNP - reduced hospital LOS - reduced 1-year mortality (17.8% vs.24.8%) | Sevoflurane was administered continuously but without a pre- or postconditioning strict protocol | |
| Meta-analysis of RCTs (58) | On-pump and of- pump CABG (6,105) | VA vs. TIVA | Sevoflurane compared with propofol was associated with: - reduced 180-day to 1-year mortality - reduced postoperative use of inotropes and vasopressors | Some evidence of benefit on cardiac index for sevoflurane and desflurane | |
| Cohort study and propensity score matching | Cardiac surgery (17,771) | Sevoflurane vs. TIVA | No differences in 30-day mortality PMI, CKMB level and new dialysis No differences in long time stay in ICU, new ischaemic event and mortality within 6-months after the procedure | Study presented as an abstract only | |
| Multicentre RCT | Elective isolated CABG surgery (5,400, 64% on pump) | Anaesthetic regi- men including VA vs. TIVA | No significant difference in 1-year mortality (2.8% vs.3%). No significant differences in any of the secondary endpoints, such as 30-day mortality (1.4% vs.1.3%), and a composite of nonfatal PMI at 30 days or death at 30 days, death from cardiac causes at 30 days and at 1 year, hospital readmission during follow-up, and ICU and in-hospital LOS | Pragmatic, single-blind controlled trial at 36 centres in 13 countries There were three different strategies for VA administration At interim analysis, the trial was stopped for futility Did not mandate postoperative measurement of cTn | |
| Meta-analysis of RCTs and TSA (89) | CABG (mostly on pump) (14,387) | VA vs. TIVA | No significant differences in operative mortality, 1-year mortality or any of the postopera- tive safety outcomes. VAs reduce ICU and hospital LOS | TSA revealed that the results for operative mortality, 1-year mortality, LOS in the ICU, heart failure, stroke and the use of IABP were inconclusive | |
| Meta-analysis of RCTs (42) | On-pump cardiac surgery (8,197) | VA vs. TIVA (mainly propofol) | VAs were associated with: - lower 1-year mortality (5.5% vs. 6.8%) - lower rate of PMI - lower cTn release - less need for inotropic medications - shorter time to extubation - higher cardiac index/output. No differences in short-term mortality (1.63% vs. 1.65%) and acute kidney injury | Studies on preconditioning or postconditioning only were excluded |