Shuo-Fang Ren1,2, Hong Yu2, Ying-Qiang Guo1, Hai Yu3. 1. Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China. 2. Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China. 3. Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China - yuhaishan117@yahoo.com.
Abstract
INTRODUCTION: Many studies have found that volatile anesthetics are associated with improved clinical outcomes for adults undergoing coronary artery bypass grafting. However, the effect of volatile anesthetics for adults after heart valve surgery has been unclear. So we conducted a meta-analysis of randomized controlled trials (RCTs) to explore whether the choice of an anesthetic regimen might influence patients' outcomes after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane Library were searched from inception to June 2018. We included eligible research comparing inhalation anesthesia with total intravenous anesthesia (TIVA) in adult patients undergoing valve surgery. The major endpoints involved mortality, postoperative arrhythmia, acute kidney injury, pulmonary complications, neurological events, myocardial infarction, reoperation for bleeding. The postoperative peak troponin release, hospital stay, Intensive Care Unit (ICU) stay and ventilation time were also analyzed. EVIDENCE SYNTHESIS: After screening through 243 potentially relevant articles, we included 13 RCTs with 962 patients. The inhalation anesthesia group revealed comparable mortality (inhalation group 12/249 [4.8%] vs. TIVA group 13/247 [5.3%], RR=0.97; 95% CI: 0.45 to 2.09; P=0.93; P for heterogeneity=0.66, I2=0%) and other postoperative complications with no heterogeneity. The postoperative peak troponin release, hospital/ICU stay and ventilation time were comparable between two groups with considerable heterogeneity. CONCLUSIONS: Among patients undergoing heart valve surgery, the use of inhalation anesthesia compared with TIVA failed to demonstrate superiority for survival and major postoperative complications, and the evidence was insufficient to draw firm conclusions due to the limited sample size. A determination of equivalence or superiority between these two anesthetic regimens requires further researches.
INTRODUCTION: Many studies have found that volatile anesthetics are associated with improved clinical outcomes for adults undergoing coronary artery bypass grafting. However, the effect of volatile anesthetics for adults after heart valve surgery has been unclear. So we conducted a meta-analysis of randomized controlled trials (RCTs) to explore whether the choice of an anesthetic regimen might influence patients' outcomes after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane Library were searched from inception to June 2018. We included eligible research comparing inhalation anesthesia with total intravenous anesthesia (TIVA) in adult patients undergoing valve surgery. The major endpoints involved mortality, postoperative arrhythmia, acute kidney injury, pulmonary complications, neurological events, myocardial infarction, reoperation for bleeding. The postoperative peak troponin release, hospital stay, Intensive Care Unit (ICU) stay and ventilation time were also analyzed. EVIDENCE SYNTHESIS: After screening through 243 potentially relevant articles, we included 13 RCTs with 962 patients. The inhalation anesthesia group revealed comparable mortality (inhalation group 12/249 [4.8%] vs. TIVA group 13/247 [5.3%], RR=0.97; 95% CI: 0.45 to 2.09; P=0.93; P for heterogeneity=0.66, I2=0%) and other postoperative complications with no heterogeneity. The postoperative peak troponin release, hospital/ICU stay and ventilation time were comparable between two groups with considerable heterogeneity. CONCLUSIONS: Among patients undergoing heart valve surgery, the use of inhalation anesthesia compared with TIVA failed to demonstrate superiority for survival and major postoperative complications, and the evidence was insufficient to draw firm conclusions due to the limited sample size. A determination of equivalence or superiority between these two anesthetic regimens requires further researches.
Authors: Jan Jedlicka; Philipp Groene; Julia Linhart; Elisabeth Raith; Da Vy Mu Stapha; Peter Conzen Journal: Anaesthesist Date: 2021-04 Impact factor: 1.041