Document Detail


Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials.
MedLine Citation:
PMID:  17678775     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery. BACKGROUND: It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans. METHODS: Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality. RESULTS: The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88). CONCLUSIONS: Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.
Authors:
Giovanni Landoni; Giuseppe G L Biondi-Zoccai; Alberto Zangrillo; Elena Bignami; Stefania D'Avolio; Chiara Marchetti; Maria Grazia Calabrò; Oliviero Fochi; Fabio Guarracino; Luigi Tritapepe; Stefan De Hert; Giorgio Torri
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2007-05-07
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  21     ISSN:  1053-0770     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-06     Completed Date:  2008-04-15     Revised Date:  2008-08-06    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  502-11     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Milan, Italy. landoni.giovanni@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Inhalation / methods*
Anesthetics, Inhalation / therapeutic use*
Cardiac Surgical Procedures / methods*
Hospital Mortality
Humans
Intraoperative Care / methods*
Intraoperative Complications / mortality,  prevention & control
Isoflurane / analogs & derivatives*,  therapeutic use
Methyl Ethers / therapeutic use*
Myocardial Infarction / mortality,  prevention & control*
Neuroprotective Agents
Prognosis
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Methyl Ethers; 0/Neuroprotective Agents; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 57041-67-5/desflurane
Comments/Corrections
Comment In:
Ann Fr Anesth Reanim. 2008 Mar;27(3):280-3   [PMID:  18418915 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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