Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery

Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery

Author Landoni, G. Google Scholar
Greco, T. Google Scholar
Biondi-Zoccai, G. Google Scholar
Nigro Neto, C. Autor UNIFESP Google Scholar
Febres, D. Google Scholar
Pintaudi, M. Google Scholar
Pasin, L. Google Scholar
Cabrini, L. Google Scholar
Finco, G. Google Scholar
Zangrillo, A. Google Scholar
Institution Ist Sci San Raffaele
Sapienza Univ Rome
Universidade Federal de São Paulo (UNIFESP)
Dante Pazzanese Inst Cardiol
Univ Cagliari
Abstract Many studies have compared desflurane, isoflurane, sevoflurane, total i.v. anaesthesia (TIVA), or all in cardiac surgery to assess their effects on patient survival.We performed standard pairwise and Bayesian network meta-analyses; the latter allows indirect assessments if any of the anaesthetic agents were not compared in head-to-head trials. Pertinent studies were identified using BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Library (last updated in June 2012).We identified 38 randomized trials with survival data published between 1991 and 2012, with most studies (63) done in coronary artery bypass grafting (CABG) patients with standard cardiopulmonary bypass. Standard meta-analysis showed that the use of a volatile agent was associated with a reduction in mortality when compared with TIVA at the longest follow-up available [25/1994 (1.3) in the volatile group vs 43/1648 (2.6) in the TIVA arm, odds ratio (OR)0.51, 95 confidence interval (CI) 0.330.81, P-value for effect0.004, number needed to treat 74, I(2)0] with results confirmed in trials with low risk of bias, in large trials, and when including only CABG studies. Bayesian network meta-analysis showed that sevoflurane (OR0.31, 95 credible interval 0.140.64) and desflurane (OR0.43, 95 credible interval 0.210.82) were individually associated with a reduction in mortality when compared with TIVA.Anaesthesia with volatile agents appears to reduce mortality after cardiac surgery when compared with TIVA, especially when sevoflurane or desflurane is used. A large, multicentre trial is warranted to confirm that long-term survival is significantly affected by the choice of anaesthetic.
Keywords anaesthesia
anaesthesia inhalation
cardiovascular surgical procedures
Language English
Date 2013-12-01
Published in British Journal of Anaesthesia. Oxford: Oxford Univ Press, v. 111, n. 6, p. 886-896, 2013.
ISSN 0007-0912 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 886-896
Origin http://dx.doi.org/10.1093/bja/aet231
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000327436600006
URI http://repositorio.unifesp.br/handle/11600/37003

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