Document Detail


Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis.
MedLine Citation:
PMID:  16793778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Previous studies have investigated the role of volatile anaesthetic agents in myocardial protection during coronary artery bypass graft (CABG) surgery, and some have identified beneficial effects. However, these studies have been too small to identify a significant effect on myocardial infarction (MI) or mortality. We undertook a systematic overview and meta-analysis of all randomized trials comparing volatile with non-volatile anaesthesia in CABG surgery. We identified 27 trials that included 2979 patients. There was no significant difference in myocardial ischaemia, MI, intensive care unit length of stay or hospital mortality between the groups (all P>0.05). Post-bypass, patients randomized to receive volatile anaesthetics had 20% higher cardiac indices (P=0.006), significantly lower troponin I serum concentrations (P=0.002) and lesser requirement for inotropic support (P=0.004) compared with those randomized to receive i.v. anaesthetics. Duration of mechanical ventilation was reduced by 2.7 h (P=0.04), and there was a 1 day decrease in hospital length of stay (P<0.001). Some of these outcomes were based on a smaller number of trials because of incomplete data, largely because the individual trials focused on one or more surrogate endpoints. We found some evidence that volatile anaesthetic agents provide myocardial protection in CABG surgery, but larger adequately powered trials with agreed, defined outcomes need to be done to fully assess a possible beneficial effect of volatile anaesthetic agents on the risk of MI and mortality.
Authors:
J A Symons; P S Myles
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2006-06-21
Journal Detail:
Title:  British journal of anaesthesia     Volume:  97     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-11     Completed Date:  2006-08-21     Revised Date:  2008-08-06    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  127-36     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia. j.symons@alfred.org.au
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MeSH Terms
Descriptor/Qualifier:
Anesthetics / pharmacology*
Coronary Artery Bypass*
Heart / drug effects*,  physiopathology
Hospital Mortality
Humans
Intensive Care
Length of Stay
Myocardial Infarction / prevention & control
Myocardial Ischemia / prevention & control
Myocardial Reperfusion Injury / prevention & control
Randomized Controlled Trials as Topic
Troponin I / blood
Chemical
Reg. No./Substance:
0/Anesthetics; 0/Troponin I
Comments/Corrections
Comment In:
Ann Fr Anesth Reanim. 2008 Mar;27(3):280-3   [PMID:  18418915 ]

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