Anaesthetic drugs and survival: A bayesian network meta-analysis of randomized trials in cardiac surgery

G. Landoni, T. Greco, G. Biondi-Zoccai, C. Nigro Neto, D. Febres, M. Pintaudi, L. Pasin, L. Cabrini, G. Finco, A. Zangrillo

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Many studies have compared desflurane, isoflurane, sevoflurane, total i.v. anaesthesia (TIVA), or all in cardiac surgery to assess their effects on patient survival. Methods. We performed standard pairwise and Bayesian network meta-analyses; the latter allows indirect assessments if any of the anaesthetic agents were not compared in head-tohead trials. Pertinent studies were identified using BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Library (last updated in June 2012). Results. We identified 38 randomized trials with survival data published between 1991 and 2012, with most studies (63%) done in coronary artery bypass grafting (CABG) patients with standard cardiopulmonary bypass. Standard meta-analysis showed that the use of a volatile agent was associated with a reduction in mortality when compared with TIVA at the longest follow-up available [25/1994 (1.3%) in the volatile group vs 43/1648 (2.6%) in the TIVA arm, odds ratio (OR)=0.51, 95% confidence interval (CI) 0.33-0.81, P-value for effect=0.004, number needed to treat 74, I 2=0%] with results confirmed in trials with low risk of bias, in large trials, and when including only CABG studies. Bayesian network metaanalysis showed that sevoflurane (OR=0.31, 95% credible interval 0.14-0.64) and desflurane (OR=0.43, 95% credible interval 0.21-0.82) were individually associated with a reduction in mortality when compared with TIVA. Conclusions. Anaesthesia with volatile agents appears to reduce mortality after cardiac surgery when compared with TIVA, especially when sevoflurane or desflurane is used. A large, multicentre trial is warranted to confirm that long-term survival is significantly affected by the choice of anaesthetic.

Original languageEnglish
Pages (from-to)886-896
Number of pages11
JournalBritish Journal of Anaesthesia
Volume111
Issue number6
DOIs
Publication statusPublished - Dec 2013

Keywords

  • Anaesthesia
  • Anaesthesia inhalation
  • Cardiovascular surgical procedures

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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