Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery

Abstract

Background It is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery. Methods A systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods. Results Sixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092). Conclusions In cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery.

Anaesthetics and remote ischaemic preconditioning: do not stop the music, despite a (yet) unhappy marriage

“…These effects have been labeled ''anaesthetic preconditioning'' and ''anaesthetic postconditioning'' when applied before myocardial ischaemia or upon reperfusion, respectively. That patients undergoing cardiac surgery fare better when receiving a volatile anaesthetic-based regimen, and that this may have added effects on top of RIPC has been suggested by metaanalyses [14,24,25]. This also raises questions.…”

How “Volatile” Is the Protection Provided by Inhalational Anesthetics?

“…While that makes sense, we do not know if isoflurane, sevoflurane, and desflurane are equally protective. Uhlig et al 1 point out that sevoflurane and desflurane seemed more protective than isoflurane in cardiac surgery patients. 4.…”

“…Additionally, the degree of injury certainly matters, which could explain the findings of the current study. 1 2. The mode of application of volatile anesthetics may play an important role.…”

“…I n this issue of Anesthesiology, Uhlig et al 1 compare morbidity and mortality with volatile anesthetics versus total intravenous anesthesia in a comprehensive meta-analysis of 68 published randomized controlled trials (RCts) that included 7104 patients. The authors found that outcomes in patients undergoing cardiac surgery were different from outcomes in other patient groups, and they stratified their results accordingly.…”

Volatile anesthetics for lung protection: a bridge between operating rooms and intensive care units?

“…The best insights in this setting come from eight studies that showed a significant decrease in mortality when comparing IAs versus total intravenous anesthesia (TIVA) (2)(3)(4)(5)(6)(7)(8)(9).…”