Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

Dib, Regina El; Pereira, José Eduardo Guimarães; Agarwal, Arnav; Gomaa, Huda; Ayala, Ana Patricia; Botan, Andresa Graciutti; Braz, Leandro Gobbo; Oliveira, Luciane Dias de; Lopes, Luciane Cruz; Mathew, Preethy J

doi:10.1016/j.jclinane.2017.05.010

Cited by 25 publications

(24 citation statements)

References 73 publications

(193 reference statements)

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“…Nevertheless, there is clinical evidence showing that general anesthetics protect against organ injuries during and/or after surgery although it has always been debatable. Some papers suggest that volatile anesthesia may produce more myocardial protection compared to propofol 48 – 51 . Conversely, propofol was also reported to provide comparable myocardial protectivity like that of isoflurane in patients undergoing coronary artery bypass graft surgery 52 .…”

Section: Discussionmentioning

confidence: 99%

Propofol-induced MiR-20b expression initiates endogenous cellular signal changes mitigating hypoxia/re-oxygenation-induced endothelial autophagy in vitro

Wang

Cai

et al. 2020

Cell Death Dis

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Certain miRNAs can attenuate hypoxia/re-oxygenation-induced autophagic cell death reported in our previous studies, but how these miRNAs regulate the autophagy-related cellular signaling pathway in preventing cell death is largely unknown. In the current study, the autophagy-related miRNAs of hsa-miR-20b were investigated in an in vitro model of hypoxia/re-oxygenation-induced endothelial autophagic cell death. Of these, miR-20b was found to be the most important miRNA which targeted on the key autophagy kinase ULK1 and inhibited hypoxia/re-oxygenation injury-induced autophagy by decreasing both autophagosomes and LC3I to II transition rate and P62 degradation. These processes were reversed by the transfection of an miR-20b inhibitor. Re-expression of ULK1 restores miR-20b-inhibited autophagy. Propofol, a commonly used anesthetic, promoted miR-20b and METTL3 expression and attenuated endothelial autophagic cell death. The inhibited endogenous expression of miR-20b or silenced METTL3 diminished the protective effect of propofol and accentuated autophagy. Additionally, METTL3 knockdown significantly inhibited miR-20b expression but up-regulated pri-miR-20b expression. Together, our data shows that propofol protects against endothelial autophagic cell death induced by hypoxia/re-oxygenation injury, associated with activation of METTL3/miR-20b/ULK1 cellular signaling.

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Section: Discussionmentioning

confidence: 99%

Propofol-induced MiR-20b expression initiates endogenous cellular signal changes mitigating hypoxia/re-oxygenation-induced endothelial autophagy in vitro

Wang

Cai

et al. 2020

Cell Death Dis

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“…The effect of volatile anesthetic agents on outcome in cardiac surgery remains a topic of debate [40]. Özarslan et al compared the effect of various volatile anesthetics agents on sublingual microcirculatory perfusion and showed that sevoflurane compared to isoflurane and desflurane reduced microcirculatory perfusion during cardiac surgery, as reflected by a significantly lower PPV in small vessels during CPB.…”

Section: Cabg With Mecc -~Mfi -~Mfi --mentioning

confidence: 99%

Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

Brom

Leeuwen

et al. 2020

Crit Care

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Background: Microcirculatory perfusion disturbances are associated with increased morbidity and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Technological advancements made it possible to monitor sublingual microcirculatory perfusion over time. The goal of this review is to provide an overview of the course of alterations in sublingual microcirculatory perfusion following CPB. The secondary goal is to identify which parameter of sublingual microcirculatory perfusion is most profoundly affected by CPB. Methods: PubMed and Embase databases were systematically searched according to PRISMA guidelines and as registered in PROSPERO. Studies that reported sublingual microcirculatory perfusion measurements before and after onset of CPB in adult patients undergoing cardiac surgery were included. The primary outcome was sublingual microcirculatory perfusion, represented by functional capillary density (FCD), perfused vessel density (PVD), total vessel density (TVD), proportion of perfused vessels (PPV), and microvascular flow index (MFI). Results: The search identified 277 studies, of which 19 fulfilled all eligibility criteria. Initiation of CPB had a profound effect on FCD, PVD, or PPV. Seventeen studies (89%) reported one or more of these parameters, and in 11 of those studies (65%), there was a significant decrease in these parameters during cardiac surgery; the other 6 studies (35%) reported no effect. In 29% of the studies, FCD, PVD, or PPV normalized by the end of cardiac surgery, and in 24% percent of the studies, this effect lasted at least 24 h. There was no clear effect of CPB on TVD and a mixed effect on MFI. Conclusion: CPB during cardiac surgery impaired sublingual microcirculatory perfusion as reflected by reduced FCD, PVD, and PPV. Four studies reported this effect at least 24 h after surgery. Further research is warranted to conclude on the duration of CPB-induced microcirculatory perfusion disturbances and the relationship with clinical outcome.

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“…In 2006, two meta-analyses of randomized controlled trials (RCTs) suggested that volatile anesthetics were not associated with reduced mortality when compared with total intravenous anesthesia (TIVA) in CABG surgery [8,9]. On the other hand, meta-analyses published later have shown a reduced mortality associated with volatile anesthetics in CABG surgeries [10–14]. Finally, both the guideline from the American College of Cardiology/American Heart Association (ACCF/AHA) and the guideline from the European Association for Cardio-Thoracic Surgery (EACTS) have recommended the use of volatile anesthetics in patients undergoing CABG surgery [15,16].…”

Section: Introductionmentioning

confidence: 99%

Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials

Jiao

Lin

et al. 2019

PLoS ONE

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BackgroundThe benefits of volatile anesthetics in coronary artery bypass grafting (CABG) patients remain controversial. We aimed to conduct an updated meta-analysis to assess whether the use of volatile anesthetics during CABG could reduce mortality and other outcomes.MethodsWe searched eight databases from inception to June 2019 and included randomized controlled trials (RCTs) comparing the effects of volatile anesthetics versus total intravenous anesthesia (TIVA) in CABG patients. The primary outcomes were operative mortality and one-year mortality. The secondary outcomes included the length of stay in the intensive care unit (ICU) and hospital and postoperative safety outcomes (myocardial infarction, heart failure, arrhythmia, stroke, delirium, postoperative cognitive impairment, acute kidney injury, and the use of intra-aortic balloon pump (IABP) or other mechanical circulatory support). Trial sequential analysis (TSA) was performed to control for random errors.ResultsA total of 89 RCTs comprising 14,387 patients were included. There were no significant differences between the volatile anesthetics and TIVA groups in operative mortality (relative risk (RR) = 0.92, 95% confidence interval (CI): 0.68–1.24, p = 0.59, I2 = 0%), one-year mortality (RR = 0.64, 95% CI: 0.32–1.26, p = 0.19, I2 = 51%), or any of the postoperative safety outcomes. The lengths of stay in the ICU and hospital were shorter in the volatile anesthetics group than in the TIVA group. TSA revealed that the results for operative mortality, one-year mortality, length of stay in the ICU, heart failure, stroke, and the use of IABP were inconclusive.ConclusionsConventional meta-analysis suggests that the use of volatile anesthetics during CABG is not associated with reduced risk of mortality or other postoperative safety outcomes when compared with TIVA. TSA shows that the current evidence is insufficient and inconclusive. Thus, future large RCTs are required to clarify this issue.

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Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

Cited by 25 publications

References 73 publications

Propofol-induced MiR-20b expression initiates endogenous cellular signal changes mitigating hypoxia/re-oxygenation-induced endothelial autophagy in vitro

Propofol-induced MiR-20b expression initiates endogenous cellular signal changes mitigating hypoxia/re-oxygenation-induced endothelial autophagy in vitro

Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials

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