Effect of volatile anesthetics on myocardial infarction after coronary artery surgery: a post hoc analysis of a randomized trial
J. cardiothoracic vasc. anest
; 36(8,pt.A): 2454-2462, Jan. 2022.
Article
in En
| CONASS, SES-SP, SESSP-IDPCPROD, SES-SP
| ID: biblio-1359687
Responsible library:
BR79.1
ABSTRACT
OBJECTIVE:
To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG).DESIGN:
A post hoc analysis of a randomized trial.SETTING:
Cardiac surgical operating rooms.PARTICIPANTS:
Patients undergoing elective, isolated CABG.INTERVENTIONS:
Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. Measurements and mainResults:
A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03).CONCLUSIONS:
An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
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Collection:
06-national
/
BR
Database:
CONASS
/
SES-SP
/
SESSP-IDPCPROD
Main subject:
Transplants
/
Desflurane
/
Anesthesia, Intravenous
Type of study:
Clinical_trials
Language:
En
Journal:
J. cardiothoracic vasc. anest
Year:
2022
Document type:
Article