title: The effect of isoflurane on survival and myocardial infarction: a meta-analysis of randomized controlled studies.
abstract: OBJECTIVE
  The aim of this meta-analysis was to investigate the cardioprotective properties of isoflurane versus any comparator in terms of the rate of myocardial infarction and all-cause mortality.
  
  
  METHODS
  Pertinent studies were searched independently in Biomed, Central, PubMed, Embase, and the Cochrane Central Register of clinical trials. The primary endpoint was mortality at the longest follow-up available.
  
  
  METHODS
  A hospital.
  
  
  METHODS
  Randomized controlled trials.
  
  
  METHODS
  A meta-analysis of 37 trials.
  
  
  RESULTS
  The 37 included trials randomized 3,539 patients in cardiac (16 studies) and in noncardiac surgery (21 studies) with noninhalation comparators in 55% of trials. The overall analysis showed no difference in mortality between the isoflurane and control groups (16/1,602 [1.0%] v 23/1,937 [1.2%], odds ratios (OR) = 0.76 [0.39-1.47], p = 0.4 with 37 studies included) and no difference in the rate of myocardial infarction (3/1,312 [0.2%] v 1/1,532 [0.07%], OR = 2.03 [0.27-15.49], p = 0.5 with 30 studies included). Mortality was reduced in the isoflurane group when only studies with a low risk of bias were included in the analyses (0/540 [0%] v 5/703 [0.7%] in the control arm, OR = 0.13 [0.02-0.76], p = 0.02) with 4 cardiac and 6 noncardiac trials included and 5 noninhalation and 5 inhalation agents as the comparator. A trend was noted when a subanalysis was performed with propofol as a comparator (1/544 [0.2%] v 6/546 [1.1%], p = 0.05, with 16 studies included).
  
  
  CONCLUSIONS
  Isoflurane reduced mortality in high-quality studies and showed a trend toward a reduction in mortality when it was compared with propofol. No differences in the rates of overall mortality and myocardial infarction were noted.
authors: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
authors: Elena
authors: E
authors: Bignami
authors: Teresa
authors: T
authors: Greco
authors: Luigi
authors: L
authors: Barile
authors: Simona
authors: S
authors: Silvetti
authors: Davide
authors: D
authors: Nicolotti
authors: Oliviero
authors: O
authors: Fochi
authors: Elio
authors: E
authors: Cama
authors: Roberto
authors: R
authors: Costagliola
authors: Giovanni
authors: G
authors: Landoni
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Alberto
authors: A
authors: Zangrillo
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D007530:Isoflurane