[Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis].
OBJECTIVE
Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction.


METHODS
Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables.


RESULTS
17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32 to 1.95), MI (RR=0.96, 95% CI=0.52 to 1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50 to 0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26).


CONCLUSIONS
There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.
Universidade Federal de Alagoas, Maceió, AL, Brasil. Electronic address: fabianotimbo@yahoo.com.br.
Fabiano Timbó
FT
Barbosa
Hospital Unimed, Maceió, AL, Brasil.
Rafael Martins da
RM
Cunha
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Fernando Wagner da Silva
FW
Ramos
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Fernando José Camello de
FJ
Lima
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Amanda Karine Barros
AK
Rodrigues
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Ailton Mota do Nascimento
AM
Galvão
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Célio Fernando
CF
de Sousa-Rodrigues
Universidade Federal de Alagoas, Maceió, AL, Brasil.
Paula Monique Barbosa
PM
Lima
Anestesia geral; Anestesia neuroaxial; Coronary artery bypass; General anesthesia; Metanálise; Meta‐analysis; Mortalidade; Mortality; Neuraxial anesthesia; Revascularização miocárdica