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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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Li XF, Mao WJ, Jiang RJ, Yu H, Zhang MQ, Yu H. Effect of Mechanical Ventilation Mode Type on Postoperative Pulmonary Complications After Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2024; 38:437-444. [PMID: 38105126 DOI: 10.1053/j.jvca.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES It is unknown whether there is a difference in pulmonary outcome in different intraoperative ventilation modes for cardiac surgery with cardiopulmonary bypass (CPB). The aim of this trial was to determine whether patients undergoing cardiac surgery with CPB could benefit from intraoperative optimal ventilation mode. DESIGN This was a single-center, prospective, randomized controlled trial. SETTING The study was conducted at a single-center tertiary-care hospital. PARTICIPANTS A total of 1,364 adults undergoing cardiac surgery with CPB participated in this trial. INTERVENTIONS Patients were assigned randomly (1:1:1) to receive 1 of 3 ventilation modes: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG). All arms of the study received the lung-protective ventilation strategy. MEASUREMENTS AND MAIN RESULTS The primary outcome was a composite of postoperative pulmonary complications (PPCs) within the first 7 postoperative days. Pulmonary complications occurred in 168 of 455 patients (36.9%) in the PCV-VG group, 171 (37.6%) in the PCV group, and 182 (40.1%) in the VCV group, respectively. There was no statistical difference in the risk of overall pulmonary complications among groups (p = 0.585). There were no significant differences in the severity grade of PPCs within 7 days, postoperative ventilation duration, intensive care unit stay, postoperative hospital stay, or 30-day postoperative mortality. CONCLUSIONS Among patients scheduled for cardiac surgery with CPB, intraoperative ventilation mode type did not affect the risk of postoperative pulmonary complications.
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Affiliation(s)
- Xue-Fei Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jie Mao
- Department of Anesthesiology, Jianyang People's Hospital, Jianyang, China
| | - Rong-Juan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Meng-Qiu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Gong C, Zhou X, Fang Y, Zhang Y, Zhu L, Ding Z. Effects of sevoflurane on left ventricular function by speckle-tracking echocardiography in coronary bypass patients: A randomized trial. J Biomed Res 2023; 38:76-86. [PMID: 38044669 PMCID: PMC10818177 DOI: 10.7555/jbr.37.20230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography, and to assess the effect of sevoflurane on cardiac function. Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia (AS) group and a propofol-based total intravenous anesthesia (AA) group. The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T 1 (after harvesting all grafts and before coronary anastomosis) and T 2 (30 min after completing all coronary anastomoses) ( P < 0.05). Moreover, strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group, compared with the AA group at both T 1 and T 2 ( P < 0.01). The flow of the left internal mammary artery-left anterior descending artery graft was superior, and the postoperative concentration of troponin T decreased rapidly in the AS group, compared with the AA group ( P < 0.05). Compared with total intravenous anesthesia, sevoflurane resulted in a significantly higher global longitudinal strain, stroke volume, and cardiac output. Sevoflurane also led to an amelioration in the condition of the arterial graft. Furthermore, sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value. The findings need to be replicated in larger studies.
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Affiliation(s)
- Chanjuan Gong
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaokai Zhou
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yin Fang
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yanjuan Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Linjia Zhu
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhengnian Ding
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Li XF, Jiang RJ, Mao WJ, Yu H, Xin J, Yu H. The effect of driving pressure-guided versus conventional mechanical ventilation strategy on pulmonary complications following on-pump cardiac surgery: A randomized clinical trial. J Clin Anesth 2023; 89:111150. [PMID: 37307653 DOI: 10.1016/j.jclinane.2023.111150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
STUDY OBJECTIVE Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery. DESIGN Prospective, two-arm, randomized controlled trial. SETTING The West China university hospital in Sichuan, China. PATIENTS Adult patients who were scheduled for elective on-pump cardiac surgery were enrolled in the study. INTERVENTIONS Patients undergoing on-pump cardiac surgery were randomized to receive driving pressure-guided ventilation strategy based on positive end-expiratory pressure (PEEP) titration or conventional lung-protective ventilation strategy with fixed 5 cmH2O of PEEP. MEASUREMENTS The primary outcome of pulmonary complications (including acute respiratory distress syndrome, atelectasis, pneumonia, pleural effusion, and pneumothorax) within the first 7 postoperative days were prospectively identified. Secondary outcomes included pulmonary complication severity, ICU length of stay, and in-hospital and 30-day mortality. MAIN RESULTS Between August 2020 and July 2021, we enrolled 694 eligible patients who were included in the final analysis. Postoperative pulmonary complications occurred in 140 (40.3%) patients in the driving pressure group and 142 (40.9%) in the conventional group (relative risk, 0.99; 95% confidence interval, 0.82-1.18; P = 0.877). Intention-to-treat analysis showed no significant difference between study groups regarding the incidence of primary outcome. The driving pressure group had less atelectasis than the conventional group (11.5% vs 17.0%; relative risk, 0.68; 95% confidence interval, 0.47-0.98; P = 0.039). Secondary outcomes did not differ between groups. CONCLUSION Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy.
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Affiliation(s)
- Xue-Fei Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rong-Juan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu 610041, China
| | - Wen-Jie Mao
- Department of Anesthesiology, Jianyang People's Hospital, Jianyang 641400, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Juan Xin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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O'Donnell CT, Fielding-Singh V, Vanneman MW. The Art of the Null Hypothesis-Considerations for Study Design and Scientific Reporting. J Cardiothorac Vasc Anesth 2023; 37:867-869. [PMID: 36933992 DOI: 10.1053/j.jvca.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Christian T O'Donnell
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Vikram Fielding-Singh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Matthew W Vanneman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Ștefan M, Predoi C, Goicea R, Filipescu D. Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review. J Clin Med 2022; 11:jcm11206031. [PMID: 36294353 PMCID: PMC9604446 DOI: 10.3390/jcm11206031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
Recent research has contested the previously accepted paradigm that volatile anaesthetics improve outcomes in cardiac surgery patients when compared to intravenous anaesthesia. In this review we summarise the mechanisms of myocardial ischaemia/reperfusion injury and cardioprotection in cardiac surgery. In addition, we make a comprehensive analysis of evidence comparing outcomes in patients undergoing cardiac surgery under volatile or intravenous anaesthesia, in terms of mortality and morbidity (cardiac, neurological, renal, pulmonary).
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Affiliation(s)
- Mihai Ștefan
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Correspondence:
| | - Cornelia Predoi
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Goicea
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Filipescu
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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