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Deng XQ, Yu H, Wang WJ, Wu QL, Wei H, Deng JS, Li ZJ, Wu JZ, Yang JJ, Zheng XM, Wei JJ, Fan SS, Zou XH, Shi J, Zhang FX, Wu DQ, Kou DP, Wang T, Wang E, Ye Z, Zheng X, Chen G, Huang WQ, Chen Y, Wei X, Chai XQ, Huang WQ, Wang L, Li K, Li L, Zhang Y, Li R, Jiao JL, Yu H, Liu J. Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: a multicentre randomised trial. Br J Anaesth 2024; 133:296-304. [PMID: 38839471 DOI: 10.1016/j.bja.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).
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Affiliation(s)
- Xiao-Qian Deng
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Yu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Jian Wang
- Department of Anaesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiao-Lin Wu
- Department of Anaesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Wei
- Department of Anaesthesiology, Gaozhou People's Hospital, Guangdong, China
| | - Jing-Song Deng
- Department of Anaesthesiology, Gaozhou People's Hospital, Guangdong, China
| | - Zhi-Jian Li
- Department of Anaesthesiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin-Zheng Wu
- Department of Anaesthesiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian-Jun Yang
- Department of Anaesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang-Ming Zheng
- Department of Anaesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin-Ju Wei
- Department of Anaesthesiology, Cardiovascular Hospital (The 7th People's Hospital of Zhengzhou), Zhengzhou, China
| | - Shuai-Shuai Fan
- Department of Anaesthesiology, Cardiovascular Hospital (The 7th People's Hospital of Zhengzhou), Zhengzhou, China
| | - Xiao-Hua Zou
- Department of Anaesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Shi
- Department of Anaesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fang-Xiang Zhang
- Department of Anaesthesiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Da-Qing Wu
- Department of Anaesthesiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Dang-Pei Kou
- Department of Anaesthesiology, Tianjin Chest Hospital, Tian Jin, China
| | - Tao Wang
- Department of Anaesthesiology, Tianjin Chest Hospital, Tian Jin, China
| | - E Wang
- Department of Anaesthesiology, Xiangya Hospital of Central South University, National Clinical Research Centre for Geriatric Disorders, Central South University, Changsha, China
| | - Zhi Ye
- Department of Anaesthesiology, Xiangya Hospital of Central South University, National Clinical Research Centre for Geriatric Disorders, Central South University, Changsha, China
| | - Xing Zheng
- Department of Anaesthesiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Gang Chen
- Department of Anaesthesiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Wen-Qi Huang
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Chen
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Wei
- Department of Anaesthesiology, Anhui Provincial Hospital, Hefei, China
| | - Xiao-Qing Chai
- Department of Anaesthesiology, Anhui Provincial Hospital, Hefei, China
| | - Wei-Qin Huang
- Department of Anaesthesiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Ling Wang
- Department of Anaesthesiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Kai Li
- Department of Anaesthesiology, China Japan Union Hospital, Jilin University, Changchun, China
| | - Liang Li
- Department of Anaesthesiology, China Japan Union Hospital, Jilin University, Changchun, China
| | - Ye Zhang
- Department of Anaesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Li
- Department of Anaesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jia-Li Jiao
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hai Yu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Jin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Makkad B, Heinke TL, Kertai MD. Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist? Curr Opin Anaesthesiol 2022; 35:18-35. [PMID: 34873076 DOI: 10.1097/aco.0000000000001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. RECENT FINDINGS Recent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery. SUMMARY Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.
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Affiliation(s)
- Benu Makkad
- Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Uhlig C, Labus J. Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: a Narrative Review. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:275-283. [PMID: 34276252 PMCID: PMC8271298 DOI: 10.1007/s40140-021-00466-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
Purpose of the Review The present review addresses clinicians and gives an overview about the experimental rationale for pharmacological conditioning associated with volatile anesthetics, opioids, and propofol; the current clinical data; and the technical considerations regarding the clinical routine in cardiac anesthesia. Recent Findings Volatile anesthetics have been standard of care for general anesthesia for cardiac surgery, especially while using cardiopulmonary bypass. The 2019 published MYRIAD trial was not able to show a difference in mortality or cardiac biomarkers for volatile anesthetics compared to total intravenous anesthesia (TIVA), raising the question of equivalence with respect to patient outcome. Summary Reviewing the literature, the scientific foundation for the belief of clinically relevant conditioning by uninterrupted administration of a volatile anesthetic is weak. TIVA can also be performed safely in patients undergoing cardiac surgery.
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Affiliation(s)
- Christopher Uhlig
- Department of Cardiac Anesthesiology, Heart Center Dresden University Hospital, Fetscherstr. 76, 01307 Dresden, Germany
| | - Jakob Labus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne University, Albertus-Magnus-Platz, 50923 Cologne, Germany
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