Preventing mortality in cardiac surgery with anesthetic drugs and techniques. There is need for a consensus conference.

Anesthesiologists use a variety of drugs that have non-anesthetic, pharmacological properties that could reduce early and long term mortality in patients undergoing cardiac surgery.

The use of specific anesthetic drugs [1,2,3] and techniques [4], together with drugs managed mainly by cardiac anesthesiologists[5,6,7,8,9] have recently been associated with improved perioperative survival in cardiac surgery . [10] The numbers needed to treat are impressive (Table 1).

Agents to reduce perioperative mortality in cardiac surgery with the number needed to treat (NNT) to prevent one death. All data are derived from meta-analysis of randomized controlled trials.

*For epidural analgesia the composite end point mortality and/or myocardial infarction is considered

Anesthesiologists should try and identify more drugs and techniques with similar extraordinary properties and, at the same time, study them prospectively with large multicentre randomized controlled trials. The Italian Association for Cardiothoracic Anesthesia (ITACTA) is conducting large, non-sponsored,randomized multicentre trials to clearly document the beneficial effects of volatile agents, levosimendan, fenoldopam and desmopressin in patients with or at high risk for severe myocardial dysfunction, acute renal failure and blood transfusion complications (see www.clinicaltrials.org for details).

We think it’s time to call for an international consensus conference to identify which agents are really beneficial for clinically relevant outcomes (all-cause mortality) in cardiac surgery and anesthesia. The aim of this consensus conference will be to identify any drug or technique that can reduce (or increase) short or long term mortality in patients undergoing cardiac surgery as suggested by at least one randomized controlled trial (RCT) or by a meta-analysis of RCTs or by a subgroup analysis of RCT/metaanalysis. Readers of “HSR Proceedings in Intensive Care and Cardiovascular Anesthesia” are invited to send email contributions (pdf papers on drugs or techniques that can affect mortality in cardiac anesthesia/surgery) and suggestions to landoni.giovanni@hsr.it .

Their contribution will be acknowledged and the suggested papers will be evaluated in the consensus conference. They’ll also be welcome to participate to the consensus conference that will be held in Milano in 2010. Non-randomized evidence and suggestions will be considered if time permits.