Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials


Autoři: Xue-feng Jiao aff001;  Xue-mei Lin aff003;  Xiao-feng Ni aff001;  Hai-long Li aff001;  Chuan Zhang aff001;  Chun-song Yang aff001;  Hao-xin Song aff001;  Qiu-sha Yi aff001;  Ling-li Zhang aff001
Působiště autorů: Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China aff001;  Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Sichuan, China aff002;  Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China aff003;  West China School of Medicine, Sichuan University, Sichuan, China aff004;  Department of Anesthesiology, West China Second University Hospital, Sichuan University, Sichuan, China aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224562

Souhrn

Background

The benefits of volatile anesthetics in coronary artery bypass grafting (CABG) patients remain controversial. We aimed to conduct an updated meta-analysis to assess whether the use of volatile anesthetics during CABG could reduce mortality and other outcomes.

Methods

We searched eight databases from inception to June 2019 and included randomized controlled trials (RCTs) comparing the effects of volatile anesthetics versus total intravenous anesthesia (TIVA) in CABG patients. The primary outcomes were operative mortality and one-year mortality. The secondary outcomes included the length of stay in the intensive care unit (ICU) and hospital and postoperative safety outcomes (myocardial infarction, heart failure, arrhythmia, stroke, delirium, postoperative cognitive impairment, acute kidney injury, and the use of intra-aortic balloon pump (IABP) or other mechanical circulatory support). Trial sequential analysis (TSA) was performed to control for random errors.

Results

A total of 89 RCTs comprising 14,387 patients were included. There were no significant differences between the volatile anesthetics and TIVA groups in operative mortality (relative risk (RR) = 0.92, 95% confidence interval (CI): 0.68–1.24, p = 0.59, I2 = 0%), one-year mortality (RR = 0.64, 95% CI: 0.32–1.26, p = 0.19, I2 = 51%), or any of the postoperative safety outcomes. The lengths of stay in the ICU and hospital were shorter in the volatile anesthetics group than in the TIVA group. TSA revealed that the results for operative mortality, one-year mortality, length of stay in the ICU, heart failure, stroke, and the use of IABP were inconclusive.

Conclusions

Conventional meta-analysis suggests that the use of volatile anesthetics during CABG is not associated with reduced risk of mortality or other postoperative safety outcomes when compared with TIVA. TSA shows that the current evidence is insufficient and inconclusive. Thus, future large RCTs are required to clarify this issue.

Klíčová slova:

Anesthetics – Cognitive impairment – Coronary artery bypass grafting – Heart failure – Hospitals – Intensive care units – Metaanalysis – Surgical and invasive medical procedures


Zdroje

1. Alexander JH, Smith PK. Coronary-Artery Bypass Grafting. N Engl J Med. 2016;375(10):e22.

2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137(12):e67–e492. doi: 10.1161/CIR.0000000000000558 29386200

3. Moazzami K, Dolmatova E, Maher J, Gerula C, Sambol J, Klapholz M, et al. In-Hospital Outcomes and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012. Journal of cardiothoracic and vascular anesthesia. 2017;31(1):19–25. doi: 10.1053/j.jvca.2016.08.008 27887898

4. Warltier DC, Pagel PS, Kersten JR. Approaches to the prevention of perioperative myocardial ischemia. Anesthesiology. 2000;92(1):253–259. doi: 10.1097/00000542-200001000-00038 10638923

5. Pagel PS, Crystal GJ. The Discovery of Myocardial Preconditioning Using Volatile Anesthetics: A History and Contemporary Clinical Perspective. Journal of cardiothoracic and vascular anesthesia. 2018;32(3):1112–1134. doi: 10.1053/j.jvca.2017.12.029 29398379

6. Meco M, Cirri S, Gallazzi C, Magnani G, Cosseta D. Desflurane preconditioning in coronary artery bypass graft surgery: a double-blinded, randomised and placebo-controlled study. Eur J Cardiothorac Surg. 2007;32(2):319–325. doi: 10.1016/j.ejcts.2007.05.005 17574858

7. Pagel PS. Myocardial protection by volatile anesthetics in patients undergoing cardiac surgery: a critical review of the laboratory and clinical evidence. Journal of cardiothoracic and vascular anesthesia. 2013;27(5):972–982. doi: 10.1053/j.jvca.2012.10.011 23623887

8. Yu CH, Beattie WS. The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis. Canadian journal of anaesthesia. 2006;53(9):906–918. doi: 10.1007/BF03022834 16960269

9. Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: A meta-analysis. British journal of anaesthesia. 2006;97(2):127–136. doi: 10.1093/bja/ael149 16793778

10. El Dib R, Guimaraes Pereira JE, Agarwal A, Gomaa H, Ayala AP, Botan AG, et al. Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials. Journal of clinical anesthesia. 2017;40:127–138. doi: 10.1016/j.jclinane.2017.05.010 28625437

11. Landoni G, Greco T, Biondi-Zoccai G, Nigro Neto C, Febres D, Pintaudi M, et al. Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. British journal of anaesthesia. 2013;111(6):886–896. doi: 10.1093/bja/aet231 23852263

12. Uhlig C, Bluth T, Schwarz K, Deckert S, Heinrich L, De Hert S, et al. Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2016;124(6):1230–1245. doi: 10.1097/ALN.0000000000001120 27065094

13. Zangrillo A, Musu M, Greco T, Di Prima AL, Matteazzi A, Testa V, et al. Additive Effect on Survival of Anaesthetic Cardiac Protection and Remote Ischemic Preconditioning in Cardiac Surgery: A Bayesian Network Meta-Analysis of Randomized Trials. PloS one. 2015;10(7):e0134264. doi: 10.1371/journal.pone.0134264 26231003

14. Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C, et al. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. Journal of cardiothoracic and vascular anesthesia. 2007;21(4):502–511. doi: 10.1053/j.jvca.2007.02.013 17678775

15. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):e652–735. doi: 10.1161/CIR.0b013e31823c074e 22064599

16. Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5–33. doi: 10.1093/ejcts/ezx314 29029110

17. Landoni G, Lomivorotov VV, Nigro Neto C, Monaco F, Pasyuga VV, Bradic N, et al. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. The New England journal of medicine. 2019;380(13):1214–1225. doi: 10.1056/NEJMoa1816476 30888743

18. Hofland J, Ouattara A, Fellahi JL, Gruenewald M, Hazebroucq J, Ecoffey C, et al. Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release: an International, Multicenter, Phase 3, Single-blinded, Randomized Noninferiority Trial. Anesthesiology. 2017;127(6):918–933. doi: 10.1097/ALN.0000000000001873 28872484

19. Likhvantsev VV, Landoni G, Levikov DI, Grebenchikov OA, Skripkin YV, Cherpakov RA. Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial. Journal of cardiothoracic and vascular anesthesia. 2016;30(5):1221–1227. doi: 10.1053/j.jvca.2016.02.030 27431595

20. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available from: www.cochrane.org/training/cochrane-handbook

21. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009; 62(10):1006–12. https://doi.org/10.1016/j.jclinepi.2009.06.005 19631508.

22. Overman DM, Jacobs JP, Prager RL, Wright CD, Clarke DR, Pasquali SK, et al. Report from the Society of Thoracic Surgeons National Database Workforce: clarifying the definition of operative mortality. World J Pediatr Congenit Heart Surg. 2013;4(1):10–12. doi: 10.1177/2150135112461924 23799748

23. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi: 10.1136/bmj.d5928 22008217

24. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490 15205295

25. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–406. doi: 10.1016/j.jclinepi.2010.07.015 21208779

26. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. doi: 10.1186/1471-2288-14-135 25524443

27. Thorlund K, Engstrøm J, Wetterslev J, Brok J, Imberger G, Gluud C. User manual for Trial Sequential Analysis (TSA). Available from: http://www.ctu.dk/tsa/files/tsa_manual.pdf

28. Cai J, Xu R, Yu X, Fang Y, Ding X. Volatile anesthetics in preventing acute kidney injury after cardiac surgery: a systematic review and meta-analysis. The Journal of thoracic and cardiovascular surgery. 2014;148(6):3127–3136. doi: 10.1016/j.jtcvs.2014.07.085 25218542

29. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, et al. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336(7651):995–998. doi: 10.1136/bmj.39490.551019.BE 18456631


Článek vyšel v časopise

PLOS One


2019 Číslo 10