Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials

Giovanni Landoni, Giuseppe G L Biondi-Zoccai, Alberto Zangrillo, Elena Bignami, Stefania D'Avolio, Chiara Marchetti, Maria Grazia Calabrò, Oliviero Fochi, Fabio Guarracino, Luigi Tritapepe, Stefan De Hert, Giorgio Torri

Research output: Contribution to journalArticle

Abstract

Objectives: The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery. Background: It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans. Methods: Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality. Results: The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88). Conclusions: Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.

Original languageEnglish
Pages (from-to)502-511
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume21
Issue number4
DOIs
Publication statusPublished - Aug 2007

Keywords

  • anesthesia
  • desflurane
  • meta-analysis
  • mortality
  • myocardial infarction
  • sevoflurane
  • volatile anesthetics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Landoni, G., Biondi-Zoccai, G. G. L., Zangrillo, A., Bignami, E., D'Avolio, S., Marchetti, C., Calabrò, M. G., Fochi, O., Guarracino, F., Tritapepe, L., De Hert, S., & Torri, G. (2007). Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials. Journal of Cardiothoracic and Vascular Anesthesia, 21(4), 502-511. https://doi.org/10.1053/j.jvca.2007.02.013