El Dib Regina, Guimarães Pereira José E, Agarwal Arnav, Gomaa Huda, Ayala Ana Patricia, Botan Andresa Graciutti, Braz Leandro Gobbo, de Oliveira Luciane Dias, Lopes Luciane Cruz, Mathew Preethy J
Institute of Science and Technology, Unesp - Univ Estadual Paulista, São Paulo, São José dos Campos, Brazil; Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Botucatu, Brazil; McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Botucatu, Brazil.
J Clin Anesth. 2017 Aug;40:127-138. doi: 10.1016/j.jclinane.2017.05.010.
To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting.
A systematic review.
A hospital-affiliated university.
The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10), MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the GRADE approach to rate overall certainty of the evidence.
In total we included 58 studies with a total of 6105 participants. The methodological quality was difficult to assess as it was poorly reported in 35 included studies (three or more domains were rated as unclear risk of bias). Two trials of sevoflurane showed a statistically significant reduction in death within 180 to 365days of surgery (on-pump) (RR 4.10, 95% CI 1.42 to 11.79; p=0.009; I=not applicable; high quality of evidence). There was also a statistically significant difference favouring sevoflurane compared to propofol on both inotropic (RR 2.11, 95% CI 1.53 to 2.90; p<0.00001; I=0%) and vasoconstrictor support needed (RR 1.51, 95% CI 1.04 to 2.22; p=0.03; I=0%) after coronary artery bypass grafting on-pump. Two trials of sevoflurane (MD -0.22, 95% CI -0.41 to -0.03; p=0.02; I=0%) and two further trials of desflurane (MD -0.33, 95% CI -0.45 to -0.20; p<0.00001; I=82%) showed a statistically significant difference on cardiac index during and after coronary artery bypass grafting on-pump, respectively.
There is high quality evidence that sevoflurane reduces death within 180 to 365days of surgery and, inotropic and vasoconstrictor support compared to propofol for patients undergoing coronary artery bypass grafting. There is also some evidence showing that the cardiac index is minimally influenced by administration of sevoflurane and desflurane compared to propofol.
比较接受体外循环或非体外循环冠状动脉搭桥术的成人使用吸入麻醉与静脉麻醉的情况。
系统评价。
一所附属医院的大学。
检索了以下数据库：Cochrane对照试验中心注册库（CENTRAL 2016年第10期）、MEDLINE、EMBASE和LILACS（从创刊至2016年10月）。我们采用GRADE方法对证据的总体确定性进行评级。
我们总共纳入了58项研究，共有6105名参与者。由于35项纳入研究报告质量较差（三个或更多领域被评为偏倚风险不明确），方法学质量难以评估。两项七氟烷试验显示，在手术180至365天内（体外循环）死亡有统计学显著降低（RR 4.10，95%CI 1.42至11.79；p = 0.009；I = 不适用；高质量证据）。在体外循环冠状动脉搭桥术后，与丙泊酚相比，七氟烷在正性肌力支持（RR 2.11，95%CI 1.53至2.90；p < 0.00001；I = 0%）和血管收缩剂支持需求（RR 1.51，95%CI 1.04至2.22；p = 0.03；I = 0%）方面也有统计学显著差异。两项七氟烷试验（MD -0.22，95%CI -0.41至-0.03；p = 0.02；I =
