Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2020 Sep 11;15(9):e0238661. doi: 10.1371/journal.pone.0238661. eCollection 2020.
We evaluated whether volatile anesthetics can improve the postoperative outcomes of non-cardiac surgery in patients with preoperative myocardial injury defined by the cardiac troponin elevation. From January 2010 to June 2018, 1254 adult patients with preoperative myocardial injury underwent non-cardiac surgery under general anesthesia and were enrolled in this study. Patients were stratified into following two groups according to anesthetic agents; 115 (9.2%) patients whose anesthesia was induced and maintained with continuous infusion of propofol and remifentanil (TIVA group) and 1139 (90.8%) patients whose anesthesia was maintainted with volatile anesthetics (VOLATILE group). The primary outcome was 30-day mortality. To diminish the remifentanil effect, a further analysis was conducted after excluding the patients who received only volatile anesthetics without remifentanil infusion. In a propensity-score matched analysis, 30-day mortality was higher in the TIVA group than the VOLATILE group (17.0% vs. 9.1%; hazard ratio [HR] 2.60; 95% confidence interval [CI], 1.14-5.93; p = 0.02). In addition, the TIVA group showed higher 30-day mortality than the VOLATILE group, even after eliminating the effect of remifentanil infusion (15.8% vs. 8.3%; HR 4.62; 95% CI, 1.82-11.74; p = 0.001). In our study, the use of volatile anesthetics showed the significant survival improvement after non-cardiac surgery in patients with preoperative myocardial injury, which appears to be irrelevant to the remifentanil use. Further studies are needed to confirm this beneficial effect of volatile anesthetics. Clinical trial number and registry URL: KCT0004349 (www.cris.nih.go.kr).
我们评估了挥发性麻醉剂是否可以改善术前心肌损伤患者（定义为心脏肌钙蛋白升高）的非心脏手术后结局。2010 年 1 月至 2018 年 6 月，共有 1254 例接受全身麻醉的术前心肌损伤成年患者接受了非心脏手术，并被纳入本研究。根据麻醉药物，患者分为以下两组：115 例（9.2%）麻醉诱导和维持使用丙泊酚和瑞芬太尼持续输注的患者（TIVA 组）和 1139 例（90.8%）麻醉维持使用挥发性麻醉剂的患者（VOLATILE 组）。主要结局为 30 天死亡率。为了消除瑞芬太尼的影响，在排除仅接受无瑞芬太尼输注的挥发性麻醉剂的患者后进行了进一步分析。在倾向评分匹配分析中，TIVA 组 30 天死亡率高于 VOLATILE 组（17.0%比 9.1%；危险比[HR]2.60；95%置信区间[CI]1.14-5.93；p=0.02）。此外，即使消除了瑞芬太尼输注的影响，TIVA 组 30 天死亡率也高于 VOLATILE 组（15.8%比 8.3%；HR 4.62；95%CI 1.82-11.74；p=0.001）。在我们的研究中，术前心肌损伤患者非心脏手术后使用挥发性麻醉剂显示出显著的生存改善，这似乎与瑞芬太尼的使用无关。需要进一步的研究来证实挥发性麻醉剂的这种有益作用。临床试验编号和注册网址：KCT0004349（www.cris.nih.go.kr）。
