Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China.
Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Sichuan, China.
PLoS One. 2019 Oct 29;14(10):e0224562. doi: 10.1371/journal.pone.0224562. eCollection 2019.
The benefits of volatile anesthetics in coronary artery bypass grafting (CABG) patients remain controversial. We aimed to conduct an updated meta-analysis to assess whether the use of volatile anesthetics during CABG could reduce mortality and other outcomes.
We searched eight databases from inception to June 2019 and included randomized controlled trials (RCTs) comparing the effects of volatile anesthetics versus total intravenous anesthesia (TIVA) in CABG patients. The primary outcomes were operative mortality and one-year mortality. The secondary outcomes included the length of stay in the intensive care unit (ICU) and hospital and postoperative safety outcomes (myocardial infarction, heart failure, arrhythmia, stroke, delirium, postoperative cognitive impairment, acute kidney injury, and the use of intra-aortic balloon pump (IABP) or other mechanical circulatory support). Trial sequential analysis (TSA) was performed to control for random errors.
A total of 89 RCTs comprising 14,387 patients were included. There were no significant differences between the volatile anesthetics and TIVA groups in operative mortality (relative risk (RR) = 0.92, 95% confidence interval (CI): 0.68-1.24, p = 0.59, I2 = 0%), one-year mortality (RR = 0.64, 95% CI: 0.32-1.26, p = 0.19, I2 = 51%), or any of the postoperative safety outcomes. The lengths of stay in the ICU and hospital were shorter in the volatile anesthetics group than in the TIVA group. TSA revealed that the results for operative mortality, one-year mortality, length of stay in the ICU, heart failure, stroke, and the use of IABP were inconclusive.
Conventional meta-analysis suggests that the use of volatile anesthetics during CABG is not associated with reduced risk of mortality or other postoperative safety outcomes when compared with TIVA. TSA shows that the current evidence is insufficient and inconclusive. Thus, future large RCTs are required to clarify this issue.
挥发性麻醉剂在冠状动脉旁路移植术（CABG）患者中的益处仍存在争议。我们旨在进行一项更新的荟萃分析，以评估 CABG 期间使用挥发性麻醉剂是否可以降低死亡率和其他结果。
我们从成立到 2019 年 6 月搜索了八个数据库，并纳入了比较挥发性麻醉剂与全静脉麻醉（TIVA）在 CABG 患者中的效果的随机对照试验（RCT）。主要结局是手术死亡率和一年死亡率。次要结局包括重症监护病房（ICU）和医院的住院时间以及术后安全性结局（心肌梗死、心力衰竭、心律失常、中风、谵妄、术后认知障碍、急性肾损伤和使用主动脉内球囊泵（IABP）或其他机械循环支持）。进行了试验序贯分析（TSA）以控制随机误差。
共纳入 89 项 RCT，包括 14387 名患者。挥发性麻醉剂组与 TIVA 组在手术死亡率（相对风险（RR）=0.92，95%置信区间（CI）：0.68-1.24，p=0.59，I2=0%）、一年死亡率（RR=0.64，95%CI：0.32-1.26，p=0.19，I2=51%）或任何术后安全性结局方面均无显著差异。挥发性麻醉剂组的 ICU 和医院住院时间短于 TIVA 组。TSA 显示手术死亡率、一年死亡率、ICU 住院时间、心力衰竭、中风和 IABP 使用的结果不确定。
常规荟萃分析表明，与 TIVA 相比，CABG 期间使用挥发性麻醉剂与降低死亡率或其他术后安全性结局的风险无关。TSA 表明，目前的证据不足且不确定。因此，需要进行未来的大型 RCT 以澄清这一问题。
