title: Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  It is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery.
  
  
  METHODS
  A systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods.
  
  
  RESULTS
  Sixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092).
  
  
  CONCLUSIONS
  In cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery.
authors.affiliation: From the Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany (C.U., T.B., M.G.d.A.); Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany (C.U.); Center for Evidence-Based Healthcare, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany (K.S., S.D., L.H., J.S.); Department of Anesthesiology, Ghent University Hospital, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (S.D.H.); Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy (G.L.); Department of Critical Care Medicine, Hospital Israelita Albert Einstein, and Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil (A.S.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (M.J.S.); and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy (P.P.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Uhlig
authors.forename: Thomas
authors.initials: T
authors.lastname: Bluth
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwarz
authors.forename: Stefanie
authors.initials: S
authors.lastname: Deckert
authors.forename: Luise
authors.initials: L
authors.lastname: Heinrich
authors.forename: Stefan
authors.initials: S
authors.lastname: De Hert
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Ary
authors.initials: A
authors.lastname: Serpa Neto
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Marcelo
authors.initials: M
authors.lastname: Gama de Abreu
mesh_terms: D006801:Humans; D000769:Anesthesia, Inhalation / Q000401:mortality / Q000706:statistics & numerical data; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D008171:Lung Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data
chemical_list: D018685:Anesthetics, Inhalation