Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials.
OBJECTIVE
The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery.


BACKGROUND
It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans.


METHODS
Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality.


RESULTS
The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88).


CONCLUSIONS
Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.
Landoni
Giovanni
G
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Milan, Italy. landoni.giovanni@hsr.it
Biondi-Zoccai
Giuseppe G L
GG
Zangrillo
Alberto
A
Bignami
Elena
E
D'Avolio
Stefania
S
Marchetti
Chiara
C
Calabrò
Maria Grazia
MG
Fochi
Oliviero
O
Guarracino
Fabio
F
Tritapepe
Luigi
L
De Hert
Stefan
S
Torri
Giorgio
G
D000769:Anesthesia, Inhalation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D000077335:Desflurane; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000401:mortality / Q000517:prevention & control; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008738:Methyl Ethers / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D018696:Neuroprotective Agents; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D018696:Neuroprotective Agents; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane