title: Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study.
abstract: BACKGROUND
  The effect of anaesthesia on postoperative outcome is unclear. Cardioprotective properties of volatile anaesthetics have been demonstrated experimentally and in haemodynamically stable patients undergoing coronary artery bypass grafting. Their effects in patients undergoing high-risk cardiac surgery have not been reported.
  
  
  METHODS
  We performed a multicentre, randomized, parallel group, controlled study among patients undergoing high-risk cardiac surgery (combined valvular and coronary surgery) in 2008-2011. One hundred subjects assigned to the treatment group received sevoflurane for anaesthesia maintenance, while 100 subjects assigned to the control group received propofol-based total i.v. anaesthesia. The primary outcome was a composite of death, prolonged intensive care unit (ICU) stay, or both. Thirty day and 1 yr follow-up, focused on mortality, was performed.
  
  
  RESULTS
  All 200 subjects completed the follow-up and were included in efficacy analyses, conducted according to the intention-to-treat principle. Death, prolonged ICU stay, or both occurred in 36 out of 100 subjects (36%) in the propofol group and in 41 out of 100 subjects (41%) in the sevoflurane group; relative risk 1.14, 95% confidence interval 0.8-1.62; P=0.5. No difference was identified in postoperative cardiac troponin release [1.1 (0.7-2) compared with 1.2 (0.6-2.4) ng ml(-1), P=0.6], 1 yr all-cause mortality [11/100 (11%) compared with 11/100 (11%), P=0.9], re-hospitalizations [20/89 (22.5%) compared with 11/89 (12.4%), P=0.075], and adverse cardiac events [10/89 (11.2%) compared with 9/89 (10.1%), P=0.8].
  
  
  CONCLUSIONS
  There was no observed beneficial effect of sevoflurane on the composite endpoint of prolonged ICU stay, mortality, or both in patients undergoing high-risk cardiac surgery.
  
  
  BACKGROUND
  ClinicalTrials.gov: identifier NCT00821262. Eudra CT (2008-001752-43).
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy landoni.giovanni@hsr.it.
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa 56124, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Guarracino
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa 56124, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cariello
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Franco
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa 56124, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Baldassarri
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Borghi
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: R D
authors.initials: RD
authors.lastname: Covello
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Gerli
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Crivellari
authors.affiliation: Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002316:Cardiotonic Agents / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology; D008875:Middle Aged; D011182:Postoperative Care / Q000706:statistics & numerical data; D015742:Propofol / Q000494:pharmacology; D000077149:Sevoflurane; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol
keywords: anaesthetics i.v., propofol; anaesthetics volatile, sevoflurane; cardiovascular anaesthesia; complications, death; heart, myocardial preservation technique