Document Detail


Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  20005129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The authors conducted a review of randomized studies to determine whether there were any advantages for clinically relevant outcomes by adding epidural analgesia in patients undergoing cardiac surgery under general anesthesia.
DESIGN: Meta-analysis.
SETTING: Hospitals.
PARTICIPANTS: A total of 2366 patients from 33 randomized trials.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS:
DATA SOURCES AND STUDY SELECTION: PubMed, BioMedCentral, CENTRAL, EMBASE, Cochrane Central Register of Controlled Trials, and conference proceedings were searched (updated January 2008) for randomized trials that compared general anesthesia with an anesthetic plan including general anesthesia and epidural analgesia in cardiac surgery. Two independent reviewers appraised study quality, with divergences resolved by consensus. Overall analysis showed that epidural analgesia reduced the risk of the composite endpoint mortality and myocardial infarction (30/1125 [2.7%] in the epidural group v 64/1241 [5.2%] in the control arm, odds ratio [OR] = 0.61 [0.40-0.95], p = 0.03 number needed to treat [NNT] = 40), the risk of acute renal failure (35/590 [5.9%] in the epidural group v 54/618 [8.7%] in the control arm, OR = 0.56 [0.34-0.93], p = 0.02, NNT = 36), and the time of mechanical ventilation (weighted mean differences = -2.48 hours [-2.64, -2.32], p < 0.001).
CONCLUSIONS: This analysis suggested that epidural analgesia on top of general anesthesia reduced the incidence of perioperative acute renal failure, the time on mechanical ventilation, and the composite endpoint of mortality and myocardial infarction in patients undergoing cardiac surgery.
Authors:
Elena Bignami; Giovanni Landoni; Giuseppe G L Biondi-Zoccai; Filippo Boroli; Melissa Messina; Elisa Dedola; Leda Nobile; Luca Buratti; Imad Sheiban; Alberto Zangrillo
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis     Date:  2009-12-11
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  24     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-02     Completed Date:  2011-05-20     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  586-97     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Analgesia, Epidural / methods,  trends*
Anesthesia, General / methods,  trends
Cardiac Surgical Procedures / methods,  trends*
Humans
Intraoperative Complications / prevention & control*
Randomized Controlled Trials as Topic / methods,  trends
Treatment Outcome
Comments/Corrections
Comment In:
J Cardiothorac Vasc Anesth. 2011 Aug;25(4):e17-9; author reply e19-20   [PMID:  21376633 ]

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


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