The authors performed a meta-analysis to investigate whether the cardioprotective
effects of volatile anesthetics translate into decreased morbidity and mortality in
patients undergoing cardiac surgery.
It is commonly believed that the choice of the primary anesthetic agent does not result
in different outcomes after cardiac surgery. Recent evidence, however, has indicated
that volatile anesthetics improve postischemic recovery at a cellular level, in isolated
hearts, in animals, and in humans.
Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria
were random allocation to treatment and comparison of a total intravenous anesthesia
regimen versus an anesthesia plan including desflurane or sevoflurane performed on
cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman
experimental studies, and no outcome data. The endpoints were the rate of perioperative
myocardial infarction and hospital mortality.
The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were
associated with significant reductions of myocardial infarctions (24/979 [2.4%] in
the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR]
= 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality
(4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for
heterogeneity = 0.88).
Desflurane and sevoflurane have cardioprotective effects that result in decreased
morbidity and mortality. The present data show for the first time that the choice
of an anesthetic regimen based on administration of halogenated anesthetics is associated
with a better outcome after cardiac surgery.