The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis

Zorrilla-Vaca, Andrés; Núñez-Patiño, Rafael A.; Torres, Valentina; Salazar-Gomez, Yudy

doi:10.1155/2017/7073401

Cited by 11 publications

(7 citation statements)

References 39 publications

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“…The choice of volatile anesthetic does not appear to affect clinical results. Isoflurane and sevoflurane were found to have no difference in patient outcomes [39].…”

Section: Anesthetic Managementmentioning

confidence: 92%

Enhanced Recovery Pathways for Cardiac Surgery

Coleman

Chen

Patel

et al. 2019

Curr Pain Headache Rep

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Purpose of Review Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care. Recent Findings Preoperatively, patient and family education, optimization of nutritional status, and antibiotic prophylaxis all improve outcomes. Recovery is also expedited by the use of multimodal analgesia, regional anesthesia, and opioid reducing approaches. Intraoperatively, the anesthesiologist can have an impact by using less-invasive monitors appropriately to guide fluid and hemodynamic management as well as maintaining normothermia. Postoperatively, early enteral feeding, mobilization, and removal of invasive lines support patient recovery. Implementation of ERAS protocol in cardiac surgery faces challenges by some unique perioperative perspectives in cardiac surgery, such as systemic anticoagulation, use of cardiopulmonary bypass, significantly more hemodynamic variations, larger volume replacement, postoperative intubation and mechanical ventilation and associated sedation, and potentially significantly more coexisting morbidities than other surgical procedures. Summary ERAS in cardiac surgery may benefit patients more related to its high risk and high cost nature. This manuscript specifically reviews the unique aspects of enhanced recovery in cardiac surgery.

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“…The choice of volatile anesthetic does not appear to affect clinical results. Isoflurane and sevoflurane were found to have no difference in patient outcomes [39].…”

Section: Anesthetic Managementmentioning

confidence: 92%

Enhanced Recovery Pathways for Cardiac Surgery

Coleman

Chen

Patel

et al. 2019

Curr Pain Headache Rep

View full text Add to dashboard Cite

show abstract

“…Se ha visto que con la anestesia inhalada los casos presentan niveles menores de troponina en comparación con aquéllos en los que se usó anestesia intravenosa. 31 La anestesia inhalada, según varios estudios, podría ser considerada como la ideal en la Unidad de Cuidados Intensivos. 32 A pesar de las teorías en las que el uso de la anestesia inhalada es beneficioso para pacientes de cirugía cardiaca, no existe aún suficiente evidencia que lo sustente.…”

Section: ¿Cuáles Son Los Beneficios Del Uso De Anestesia Inhalada En ...unclassified

Documento de posicionamiento: uso de sedación inhalada en el paciente críticamente enfermo

Carrillo-Esper¹,

Pineda²,

Mendoza³

et al. 2022

Medicina Crítica

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because it allows reflection efficiency and has a small dead space, which allows use in ventilators even with small tidal volumes. The use of inhaled sedation has been shown to be useful as an alternative to deep intravenous sedation in a number of cases. Compared to conventional sedatives used in the Intensive Care Unit (propofol, midazolam, etc.), inhaled sedation provides safe sedation, which can be used for long periods of time, lacks accumulation, which allows faster awakenings with good hemodynamic safety. and with less association with the development of delirium, however, more studies are required on its use in critically ill patients.

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“…Animal studies reported reduced neuronal death in the hippocampus of rats when a dose of 1–1.5 minimum alveolar concentration (MAC) of a volatile agent was given 15–30 min before circulatory arrest and at least 0.5 MAC of sevoflurane was given prior to commencement of CPB [ 49 ]. A meta-analysis comparing isoflurane and sevoflurane’s neuroprotective capabilities concluded that the choice of a volatile anaesthetic agent does not affect postoperative outcomes in cardiac surgery [ 53 ].…”

Section: Neuroprotection Interventionsmentioning

confidence: 99%

Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review

Chakane

Mogane

Moutlana

et al. 2021

IJERPH

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Open-heart surgery is the leading cause of neuronal injury in the perioperative state, with some patients complicating with cerebrovascular accidents and delirium. Neurological fallout places an immense burden on the psychological well-being of the person affected, their family, and the healthcare system. Several randomised control trials (RCTs) have attempted to identify therapeutic and interventional strategies that reduce the morbidity and mortality rate in patients that experience perioperative neurological complications. However, there is still no consensus on the best strategy that yields improved patient outcomes, such that standardised neuroprotection protocols do not exist in a significant number of anaesthesia departments. This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes. Furthermore, a summary of existing RCTs and large observational studies are examined to determine which strategies are supported by science and which lack definitive evidence. We have established that the overall evidence for pharmacological neuroprotection is weak. Most neuroprotective strategies are based on animal studies, which cannot be fully extrapolated to the human population, and there is still no consensus on the optimal neuroprotective strategies for patients undergoing cardiac surgery. Large multicenter studies using universal standardised neurological fallout definitions are still required to evaluate the beneficial effects of the existing neuroprotective techniques.

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The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis

Cited by 11 publications

References 39 publications

Enhanced Recovery Pathways for Cardiac Surgery

Enhanced Recovery Pathways for Cardiac Surgery

Documento de posicionamiento: uso de sedación inhalada en el paciente críticamente enfermo

Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review

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