Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
N. Engl. j. med
; 380(13): 1214-1225, Mar. 2019. gráfico, tabela
Artigo
em Inglês
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1024163
Biblioteca responsável:
BR79.1
Localização: BR79.1
ABSTRACT
BACKGROUND:
Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).METHODS:
We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.RESULTS:
A total of 5400 patients were randomly assigned 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.CONCLUSIONS:
Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.). (AU)
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Ponte de Artéria Coronária
/
Anestésicos Inalatórios
/
Anestesia Geral
/
Anestesia Intravenosa
Tipo de estudo:
Ensaio clínico controlado
/
Estudo de etiologia
Limite:
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
N. Engl. j. med
Ano de publicação:
2019
Tipo de documento:
Artigo
Instituição/País de afiliação:
Almazov National Medical Research Center/RU
/
Anestesia e Rianimazione Dipartimento Cardiovascolare Azienda Ospedaliera San Camillo Forlanini/IT
/
Anestesia e Terapia Intensiva Istituto Clinico Humanitas Rozzano/IT
/
Anesthesia and Intensive Care Department University Campus Bio-Medico of Rome/IT
/
Anesthesiology and Intensive Care Clinic University of Udine/IT
/
Beijing Anzhen Hospital Capital Medical University/CN
/
Charles University in Prague, First Faculty of Medicine and General Teaching Hospital/CZ
/
Department of Anesthesia and Intensive Care Cardiovascular Institute Dedinje/RS
/
Department of Anesthesia and Intensive Care Cardiovascular Institute/HR
/
Department of Anesthesia and Intensive Care Ural Institute of Cardiology Ekaterinburg/RU