Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis

Christopher Uhlig, Thomas Bluth, Kristin Schwarz, Stefanie Deckert, Luise Heinrich, Stefan De Hert, Giovanni Landoni, Ary Serpa Neto, Marcus J. Schultz, Paolo Pelosi, Jochen Schmitt, Marcelo Gama De Abreu

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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.

Original languageEnglish
Pages (from-to)1230-1245
Number of pages16
JournalAnesthesiology
Volume124
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Uhlig, C., Bluth, T., Schwarz, K., Deckert, S., Heinrich, L., De Hert, S., Landoni, G., Neto, A. S., Schultz, M. J., Pelosi, P., Schmitt, J., & De Abreu, M. G. (2016). Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis. Anesthesiology, 124(6), 1230-1245. https://doi.org/10.1097/ALN.0000000000001120