Volatile Agents for Cardiac Protection in Noncardiac Surgery: A Randomized Controlled Study

Zangrillo, Alberto; Testa, Valentina; Aldrovandi, Valeria; Tuoro, Antonio; Casiraghi, Giuseppina Maria; Cavenago, Francesca; Messina, M.; Bignami, Elena; Landoni, Giovanni

doi:10.1053/j.jvca.2011.06.016

Cited by 56 publications

(39 citation statements)

References 26 publications

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“…37,38 In contrast, no data suggest a clinically relevant preconditioning effect of volatile anesthetics outside the CABG surgery setting. The present, adequately sized RCT as well as a previous small study 13 failed to detect a clinically relevant effect of volatile anesthetics on the incidence of perioperative myocardial ischemia in noncardiac surgical patients at coronary risk. This growing evidence questions the recommendation to preferentially use volatile anesthetics in noncardiac surgical patients at cardiac risk 11 because volatile anesthetics are also associated with specific adverse effects.…”

Section: Discussioncontrasting

confidence: 52%

“…34 A recent small prospective and randomized study of sevoflurane versus propofol also did not detect any difference in the incidence of troponin elevation in 88 patients with CAD undergoing thoracic or vascular surgery. 13 The results of our adequately sized RCT did not detect an effect of volatile anesthetics on perioperative ischemia in noncardiac surgical patients with CAD or at risk for it. It was therefore in agreement with the preliminary results of the 2 previous studies.…”

Section: Discussionmentioning

confidence: 71%

“…However, data on myocardial preconditioning by volatile anesthetics during noncardiac surgery are scarce. A systematic review failed to retrieve studies with data on perioperative myocardial ischemia in patients undergoing noncardiac surgery, 12 and a small RCT 13 published in the meantime did not detect any protective effect of volatile anesthestics on cardiovascular end points in noncardiac surgical patients.…”

Section: Editorial See P 2671 Clinical Perspective On P 2704mentioning

confidence: 99%

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Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery

et al. 2012

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Background-Volatile anesthetics provide myocardial preconditioning in coronary surgery patients. We hypothesized that sevoflurane compared with propofol reduces the incidence of myocardial ischemia in patients undergoing major noncardiac surgery. Methods and Results-We enrolled 385 patients at cardiovascular risk in 3 centers. Patients were randomized to maintenance of anesthesia with sevoflurane or propofol. We recorded continuous ECG for 48 hours perioperatively, measured troponin T and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) on postoperative days 1 and 2, and evaluated postoperative delirium by the Confusion Assessment Method. At 6 and 12 months, we contacted patients by telephone to assess major adverse cardiac events. The primary end point was a composite of myocardial ischemia detected by continuous ECG and/or troponin elevation. Additional end points were postoperative NT-proBNP concentrations, major adverse cardiac events, and delirium. Patients and outcome assessors were blinded. We tested dichotomous end points by 2 test and NT-proBNP by Mann-Whitney test on an intention-to-treat basis. Myocardial ischemia occurred in 75 patients (40.8%) in the sevoflurane and 81 (40.3%) in the propofol group (relative risk, 1.01; 95% confidence interval, 0.78 -1.30). NT-proBNP release did not differ across allocation on postoperative day 1 or 2. Within 12 months, 14 patients (7.6%) suffered a major adverse cardiac event after sevoflurane and 17 (8.5%) after propofol (relative risk, 0.90; 95% confidence interval, 0.44 -1.83). The incidence of delirium did not differ (11.4% versus 14.4%; Pϭ0.379). Conclusions-Compared with propofol, sevoflurane did not reduce the incidence of myocardial ischemia in high-risk patients undergoing major noncardiac surgery. The sevoflurane and propofol groups did not differ in postoperative NT-proBNP release, major adverse cardiac events at 1 year, or delirium. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00286585.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 71%

Section: Editorial See P 2671 Clinical Perspective On P 2704mentioning

confidence: 99%

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Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery

et al. 2012

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“…One small study observed a lower incidence of major cardiac events in vascular surgery patients anaesthetized with a volatile agent than with an intravenous anaesthetic, 248 but two other studies in non-cardiac surgery patients observed no difference in outcome. 249,250 However, the overall incidence of perioperative adverse events was too low to be able to address the relationship between choice of anaesthetic agent and patient outcome. 251 …”

Section: Anaesthesiamentioning

confidence: 99%

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Kristensen¹,

Knuuti²,

Saraste³

et al. 2014

Revista Española de Cardiología (English Edition)

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“…Until now, if we had stepped out of the cardiac surgical operating room we would have found a discouraging situation: three medium/small randomized clinical trials (RCTs) investigating the effect of IAs in non-cardiac surgical interventions found no evidence of cardiac protection defined as a reduction in troponin release, natriuretic peptide levels or major cardiac events and reported also a similar incidence of delirium (10)(11)(12), while only a small RCT found a reduction in cardiac troponin and duration of ischemia in patients receiving IAs (13).…”

mentioning

confidence: 99%

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

et al. 2016

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Volatile Agents for Cardiac Protection in Noncardiac Surgery: A Randomized Controlled Study

Cited by 56 publications

References 26 publications

Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery

Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

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

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