title: Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis.
abstract: 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=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) 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=0.50-0.93). 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.
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil. Electronic address: fabianotimbo@yahoo.com.br.
authors.forename: Fabiano Timbó
authors.initials: FT
authors.lastname: Barbosa
authors.affiliation: Hospital Unimed, Maceió, AL, Brazil.
authors.forename: Rafael Martins
authors.initials: RM
authors.lastname: da Cunha
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Fernando Wagner
authors.initials: FW
authors.lastname: da Silva Ramos
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Fernando José Camello
authors.initials: FJ
authors.lastname: de Lima
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Amanda Karine Barros
authors.initials: AK
authors.lastname: Rodrigues
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Ailton Mota
authors.initials: AM
authors.lastname: do Nascimento Galvão
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Célio Fernando
authors.initials: CF
authors.lastname: de Sousa-Rodrigues
authors.affiliation: Universidade Federal de Alagoas, Maceió, AL, Brazil.
authors.forename: Paula Monique Barbosa
authors.initials: PM
authors.lastname: Lima
mesh_terms: D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D006406:Hematoma / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic
chemical_list: D000925:Anticoagulants
keywords: Anestesia geral; Anestesia neuroaxial; Coronary artery bypass; General anesthesia; Meta-analysis; Metanálise; Mortalidade; Mortality; Neuraxial anesthesia; Revascularização miocárdica