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Beverstock J, Park T, Alston RP, Song CCA, Claxton A, Sharkey T, Hutton S, Fathers J, Cawley W. A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia (TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2020; 35:1096-1105. [PMID: 33191042 DOI: 10.1053/j.jvca.2020.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The primary objective of this study was to compare one-year mortality in patients undergoing cardiac surgery with volatile anesthesia or total intravenous anesthesia (TIVA). Secondary objectives were to compare in-hospital and 30-day mortality, postoperative levels of creatine kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation, intensive care unit (ICU) and hospital stays. DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING International, multi-institution centers. PARTICIPANTS Adults patients undergoing heart surgery. INTERVENTIONS Volatile anesthesia and TIVA. MEASUREMENTS AND MAIN RESULTS Meta-analysis found no statistically significant difference between patients receiving TIVA and volatile anesthesia in one-year mortality (n = 6440, OR = 1.22, 95% CI 0.97 to 1.54, p = 0.09, Z = 1.67, I2 = 0%), troponin (n = 3127, SMD = 0.26, 95% CI -0.01 to 0.52, p = 0.05, Z = 1.92, I2 = 90%) and CK-MB concentration 24h postoperatively (n = 1214, SMD = 0.10, 95% CI -0.17 to 0.36, unadjusted p = 0.48, Z = 0.71, I2 = 79%), or time to tracheal extubation (n = 1059, SMD = 0.10, 95% CI -0.28 to 0.49, p = 0.60, Z = 0.53, I2 = 88%). The durations of ICU stay (n = 2003, SMD = 0.29, 95% CI 0.01 to 0.57, p = 0.04, Z = 2.05, I2 = 88%) and hospital stay (n = 1214, SMD = 0.42, 95% CI 0.10 to 0.75, p = 0.01, Z = 2.53, I2 = 91%) were shorter in the volatile anesthetic compared to TIVA group. CONCLUSIONS No significant differences in mortality (in-hospital, 30-day, 1-year), troponin and CK-MB concentrations 24 h postoperatively, or time to tracheal extubation were found between patients who had volatile anesthesia or TIVA. Compared to TIVA, volatile anesthesia was associated with shorter durations of hospital and ICU stays.
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Affiliation(s)
- Jamie Beverstock
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Park
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - R Peter Alston
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom; Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
| | - Celine Chan Ah Song
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Amy Claxton
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Sharkey
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Hutton
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph Fathers
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Will Cawley
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Pagel PS, Crystal GJ. The Discovery of Myocardial Preconditioning Using Volatile Anesthetics: A History and Contemporary Clinical Perspective. J Cardiothorac Vasc Anesth 2018; 32:1112-1134. [DOI: 10.1053/j.jvca.2017.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 12/24/2022]
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Oh CS, Park S, Wan Hong S, Kang WS, Yoon TG, Kim SH. Postoperative Delirium in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting According to the Anesthetic Agent: A Retrospective Study. J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.02.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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El Dib R, Guimarães Pereira JE, Agarwal A, Gomaa H, Ayala AP, Botan AG, Braz LG, de Oliveira LD, Lopes LC, Mathew PJ. Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2017. [DOI: 10.1016/j.jclinane.2017.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Jiang Q, Song X, Chen Z, Wang C, Luo H. Effects of remifentanil on hemodynamics, liver function and ICAM-1 expression in liver cancer patients undergoing surgery. Oncol Lett 2017; 14:872-876. [PMID: 28693245 PMCID: PMC5494752 DOI: 10.3892/ol.2017.6247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/02/2017] [Indexed: 01/28/2023] Open
Abstract
The objective of the present study was to investigate the effects of remifentanil on hemodynamics, liver function, and expression of intercellular adhesion molecule-1 (ICAM-1) in patients with liver cancer undergoing surgery. A total of 60 patients who underwent liver cancer resection in The First People's Hospital of Xiangyang, Hubei University of Medicine from January 2014 to January 2016 were selected, including 33 males and 27 females, with an average age of 54.12±4.77 years. Patients were randomly divided into the control group and experimental group (n=30 each). The control group and experimental group were anesthetized with propofol/isoflurane and remifentanil/propofol, respectively. In addition to general parameters, the following parameters were analyzed: mean systolic blood pressure and mean diastolic blood pressure were obtained before treatment, during anesthesia induction and intubation, during blockade of traction reflexes in surgery, and before extubation at the end of surgery. The recovery time from anesthesia withdrawal to spontaneous breathing, time of eye opening, time of extubation, and level of consciousness were recorded. Liver expression of ICAM-1 was measured with SABC staining, and the expression of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL) were recorded on the first, third, fifth, and seventh day after surgery. According to hemodynamic parameters, patients in the experimental group experienced a more stable condition than patients in the control group (P<0.05). In addition, the recovery time of the experimental group was shorter than that of the control group (P<0.05). Markers of liver function (AST, ALT and TBIL) of the two groups after surgery were higher than those before surgery, and the increases of the experimental group were significantly lower than those of the control group. ICAM-1 expression in the experimental group was significantly lower than in the control group (P<0.05). In conclusion, anesthesia with remifentanil better maintained the stability of hemodynamics, played a protective role against hepatic ischemia-reperfusion injury, and reduced ICAM-1 expression.
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Affiliation(s)
- Qi Jiang
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Xiuling Song
- Department of Endocrinology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Zheng Chen
- Department of Hepatobiliary Surgery, Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, Guangzhou 510275, P.R. China
| | - Conghui Wang
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Huiyu Luo
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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Cardiac troponins and volatile anaesthetics in coronary artery bypass graft surgery. Eur J Anaesthesiol 2016; 33:396-407. [DOI: 10.1097/eja.0000000000000397] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lemoine S, Tritapepe L, Hanouz JL, Puddu PE. The mechanisms of cardio-protective effects of desflurane and sevoflurane at the time of reperfusion: anaesthetic post-conditioning potentially translatable to humans? Br J Anaesth 2016; 116:456-75. [PMID: 26794826 DOI: 10.1093/bja/aev451] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Myocardial conditioning is actually an essential strategy in the management of ischaemia-reperfusion injury. The concept of anaesthetic post-conditioning is intriguing, its action occurring at a pivotal moment (that of reperfusion when ischaemia reperfusion lesions are initiated) where the activation of these cardio-protective mechanisms could overpower the mechanisms leading to ischaemia reperfusion injuries. Desflurane and sevoflurane are volatile anaesthetics frequently used during cardiac surgery. This review focuses on the efficacy of desflurane and sevoflurane administered during early reperfusion as a potential cardio-protective strategy. In the context of experimental studies in animal models and in human atrial tissues in vitro, the mechanisms underlying the cardio-protective effect of these agents and their capacity to induce post-conditioning have been reviewed in detail, underlining the role of reactive oxygen species generation, the activation of the cellular signalling pathways, and the actions on mitochondria along with the translatable actions in humans; this might well be sufficient to set the basis for launching randomized clinical studies, actually needed to confirm this strategy as one of real impact.
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Affiliation(s)
- S Lemoine
- Department of Anaesthesiology and Intensive Care, France and Faculty of Medicine, Centre Hospitalier Universitaire de Caen, Normandie Université, Pôle d'Anesthésie-Réanimation Chirurgicale - Niveau 6, CHU de Caen, Avenue Cote de Nacre, Caen Cedex 14033, France
| | - L Tritapepe
- Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - J L Hanouz
- Department of Anaesthesiology and Intensive Care, France and Faculty of Medicine, Centre Hospitalier Universitaire de Caen, Normandie Université, Pôle d'Anesthésie-Réanimation Chirurgicale - Niveau 6, CHU de Caen, Avenue Cote de Nacre, Caen Cedex 14033, France
| | - P E Puddu
- Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Jia L, Dong R, Zhang F, Wang W, Lu H, Luo Y, Xue Q, Yu B. Propofol Provides More Effective Protection for Circulating Lymphocytes Than Sevoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kunst G, Klein AA. Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia 2015; 70:467-82. [PMID: 25764404 PMCID: PMC4402000 DOI: 10.1111/anae.12975] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 12/11/2022]
Abstract
Preconditioning has been shown to reduce myocardial damage caused by ischaemia–reperfusion injury peri-operatively. Volatile anaesthetic agents have the potential to provide myocardial protection by anaesthetic preconditioning and, in addition, they also mediate renal and cerebral protection. A number of proof-of-concept trials have confirmed that the experimental evidence can be translated into clinical practice with regard to postoperative markers of myocardial injury; however, this effect has not been ubiquitous. The clinical trials published to date have also been too small to investigate clinical outcome and mortality. Data from recent meta-analyses in cardiac anaesthesia are also not conclusive regarding intra-operative volatile anaesthesia. These inconclusive clinical results have led to great variability currently in the type of anaesthetic agent used during cardiac surgery. This review summarises experimentally proposed mechanisms of anaesthetic preconditioning, and assesses randomised controlled clinical trials in cardiac anaesthesia that have been aimed at translating experimental results into the clinical setting.
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Affiliation(s)
- G Kunst
- Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London, UK
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Moscarelli M, Punjabi PP, Miroslav GI, Del Sarto P, Fiorentino F, Angelini GD. Myocardial conditioning techniques in off-pump coronary artery bypass grafting. J Cardiothorac Surg 2015; 10:7. [PMID: 25599579 PMCID: PMC4304196 DOI: 10.1186/s13019-014-0204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/26/2014] [Indexed: 11/24/2022] Open
Abstract
Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury. However, even short-term regional ischemic periods, hemodynamic instability and arrhythmias associated with the procedure can be responsible for myocardial damage. Conditioning, a potential cardio-protective tool during on-pump cardiac surgery, has hardly been investigated in the context of off-pump surgery. There are virtually no large trials on remote ischemic preconditioning and the majority of reports have focused on central ischemic conditioning. Similarly, volatile anesthetic agents with conditioning effect like ischemic preconditioning have been shown to reduce cardiac injury during on-pump procedures but have not been validated in the off-pump scenario. Here, we review the available evidence on myocardial conditioning, either with ischemia/reperfusion or volatile anesthetic agents in patients undergoing off-pump coronary artery surgery.
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Affiliation(s)
- Marco Moscarelli
- NHLI, Hammersmith Hospital, Imperial College London, London, UK. .,Fondazione Monasterio, Ospedale Pasquinucci, Massa, Italy.
| | | | - Gamov I Miroslav
- NHLI, Hammersmith Hospital, Imperial College London, London, UK.
| | | | | | - Gianni D Angelini
- NHLI, Hammersmith Hospital, Imperial College London, London, UK. .,Bristol Heart Institute, University of Bristol, Bristol, UK.
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Sevoflurane- Compared with Propofol-based Anesthesia Reduces the Need for Inotropic Support in Patients Undergoing Abdominal Aortic Aneurysm Repair: Evidence of Cardioprotection by Volatile Anesthetics in Noncardiac Surgery. Anesthesiology 2014; 120:1289-90. [DOI: 10.1097/aln.0000000000000186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pagel PS. Myocardial Protection by Volatile Anesthetics in Patients Undergoing Cardiac Surgery: A Critical Review of the Laboratory and Clinical Evidence. J Cardiothorac Vasc Anesth 2013; 27:972-82. [DOI: 10.1053/j.jvca.2012.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Indexed: 11/11/2022]
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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