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Minerva Anestesiologica 2020 October;86(10):1065-78

DOI: 10.23736/S0375-9393.20.14304-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Effect of volatile anesthetics on mortality and clinical outcomes in patients undergoing coronary artery bypass grafting: a meta-analysis of randomized clinical trials

Yi-Nan ZHANG 1, 2, 3, Lei YANG 1, Wen-Sheng ZHANG 1, 2, Jin LIU 1, 2

1 Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; 2 Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China; 3 Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China



INTRODUCTION: It remains unclear whether intraoperative use of volatile anesthetics has a positive effect on postoperative clinical outcomes in patients undergoing coronary artery bypass grafting (CABG). Therefore, we aimed to systematically analyze the long- and short-term mortality rates and the clinical outcomes of volatile anesthesia compared to those of total intravenous anesthesia (TIVA) in patients undergoing CABG.
EVIDENCE ACQUISITION: We queried the MEDLINE, Embase, and CENTRAL databases from inception to October 2019 for relevant randomized clinical trials (RCTs) on the intraoperative use of volatile anesthetics in patients undergoing CABG.
EVIDENCE SYNTHESIS: We pooled and analyzed 36 eligible RCTs with 10,308 patients and found that there was no significant difference in the long- and short-term mortality rate between the use of volatile anesthesia and TIVA during CABG. 30-day mortality, volatile group (39/2,824, 1.4%) vs. TIVA group (35/2,786, 1.3%), RR=1.11, 95% CI [0.70, 1.74], P value for effect =0.66, I2=0%, moderate-certainty evidence; One-year mortality, volatile group (77/2,749, 2.8%) vs. TIVA group (78/2,731, 2.9%), RR=0.98, 95% CI [0.72, 1.34], P value for effect =0.90, I2=0%, moderate-certainty evidence. Mechanical ventilation time was reduced in volatile group (MD -0.65, 95% CI [-1.07, -0.24], P value for effect =0.002, I2=26%).
CONCLUSIONS: There is no difference in the long- and short-term mortality and clinical outcomes between intraoperative use of volatile anesthetics and TIVA during CABG. However, volatile anesthetics may shorten the mechanical ventilation time. There is a need for high-quality multicenter RCTs that specifically assess factors that influence mortality and clinical outcomes.


KEY WORDS: Anesthesia, inhalation; Coronary artery bypass; Anesthesia, intravenous; Meta-analysis

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