Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review

Ştefan, Mihai; Predoi, Cornelia; Goicea, Raluca; Filipescu, Daniela

doi:10.3390/jcm11206031

Cited by 6 publications

(3 citation statements)

References 110 publications

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“…In contrast, propofol has the ability to maintain the functionality of natural killer cells. In addition, the use of a volatile anesthetic is linked to a more pronounced stress response compared to propofol-based TIVA [53][54][55]. As a result, propofol-based TIVA is correlated with improved overall survival.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia-related postoperative oncological surgical outcomes: a comparison of total intravenous anesthesia and volatile anesthesia. A meta-analysis.

Yan,

Liang,

Yin

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction:In patients undergoing cancer surgery, it is ambiguous whether propofol-based total intravenous anesthesia (TIVA) elicits a significantly higher overall survival rate than volatile anesthetics (VA). Consequently, evaluating the impact of TIVA and VA on long-term oncological outcomes is crucial. Aim: This study compared TIVA versus VA for cancer surgery patients and investigated the potential correlation between anesthetics and their long-term surgical outcomes. Material and methods: A comprehensive search of Medline, EMBASE, Scopus, and Cochrane Library identified English-language peer-reviewed journal papers. The statistical measurements of hazard ratio (HR) and 95% CI were calculated. We assessed heterogeneity using Cochrane Q and I 2 statistics and the appropriate p-value. The analysis used RevMan 5.3. Results: The meta-analysis included 10 studies with 14036 cancer patients, 6264 of whom received TIVA and 7777 VA. In this study, we examined the long-term oncological outcomes of cancer surgery patients with TIVA and VA. Our data show that the TIVA group had a considerably higher overall survival rate (HR = 0.49, 95% CI: 0.30-0.80) and recurrence-free survival rate (HR = 0.56, 95% CI: 0.32-0.97). Each outcome was statistically significant (p < 0.05). Conclusions: The present study concludes that TIVA is a more effective anesthetic agent than VA in obtaining better long-term oncological outcomes in cancer patients after surgery as it provides a higher overall survival rate, a higher recurrence-free survival rate and fewer post-operative pathological findings in patients who have undergone surgery for cancer as compared to VA.

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Section: Discussionmentioning

confidence: 99%

Anesthesia-related postoperative oncological surgical outcomes: a comparison of total intravenous anesthesia and volatile anesthesia. A meta-analysis.

Yan,

Liang,

Yin

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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“…Similar results have been reported when VHAs were used throughout the surgical procedure (OR 0.66 [95% CI: 0.49–0.89]) ( 58 ). Those meta-analyses included small and sometimes single-center studies ( 59 ). International guidelines are in favor of the use of VHA during cardiac surgery ( 60 , 61 ).…”

Section: Volatile Halogenated Agents-induced Myocardial Protectionmentioning

confidence: 99%

Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies

Chiari,

Fellahi

2024

Front. Med.

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Cardiac surgery with cardiopulmonary bypass results in global myocardial ischemia–reperfusion injury, leading to significant postoperative morbidity and mortality. Although cardioplegia is the cornerstone of intraoperative cardioprotection, a number of additional strategies have been identified. The concept of preconditioning and postconditioning, despite its limited direct clinical application, provided an essential contribution to the understanding of myocardial injury and organ protection. Therefore, physicians can use different tools to limit perioperative myocardial injury. These include the choice of anesthetic agents, remote ischemic preconditioning, tight glycemic control, optimization of respiratory parameters during the aortic unclamping phase to limit reperfusion injury, appropriate choice of monitoring to optimize hemodynamic parameters and limit perioperative use of catecholamines, and early reintroduction of cardioprotective agents in the postoperative period. Appropriate management before, during, and after cardiopulmonary bypass will help to decrease myocardial damage. This review aimed to highlight the current advancements in cardioprotection and their potential applications during cardiac surgery.

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“…In conclusion, aortic dissection is a serious medical condition that requires prompt diagnosis and treatment. Surgery is often required in order to repair the damaged aorta, with aortic root replacement and endovascular repair being the most common methods of repair [40]. A combination of surgical and medical treatment may be used to manage the condition and reduce the risk of complications.…”

Section: Aortic Dissectionmentioning

confidence: 99%

Optimising anesthesia support during operations on the abdominal aorta and its branches

2022

FEM

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Background: Pathology of the aorta includes aortic aneurysms, coarctation, dissection, atherosclerotic disease, and aortitis. The only two evidence-based treatment options for abdominal aortic repair are endovascular and open surgery. The anesthetic approach and medications may impact the outcomes of the surgical repair of the abdominal aorta and its branches. Aim: to evaluate the use of various analgesic regimens and local, regional, or general anesthesia in "optimising" surgical outcomes in patients undergoing surgical repair of the abdominal aorta and its branches. Methods: In this review, English studies from common databases such as Pubmed/MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane Library with the keywords "Abdominal aorta," "operations," "aortic branches," combined with keywords, involving " anesthesia were involved." The end date for this review was November 2022. Scientific novelty: Recent scientific studies have focused on the use of advanced monitoring technologies such as cerebral oximetry and microdialysis to improve the safety and efficacy of anesthesia management in aortic surgery. These technologies provide more accurate and real-time information about cerebral perfusion and metabolism, allowing the anesthesiologist to identify and manage potential complications such as cerebral ischemia more effectively. Additionally, the use of pharmacological agents such as dexmedetomidine and remifentanil has been shown to reduce the risk of postoperative delirium and cognitive dysfunction, further improving patient outcomes. Conclusion: Aortic surgery is a complex and high-risk procedure that requires careful management of anesthesia to ensure patient safety and optimal outcomes. With ongoing advances in anesthesia techniques and monitoring technologies, there is reason to be optimistic about the future of aortic surgery and the prospects for improved patient outcomes. The anesthesiologist plays a critical role in this process, working closely with the surgical team to provide safe and effective anesthesia throughout the procedure and ensuring that the patient receives appropriate pain management and other supportive care in the postoperative period

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Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review

Cited by 6 publications

References 110 publications

Anesthesia-related postoperative oncological surgical outcomes: a comparison of total intravenous anesthesia and volatile anesthesia. A meta-analysis.

Anesthesia-related postoperative oncological surgical outcomes: a comparison of total intravenous anesthesia and volatile anesthesia. A meta-analysis.

Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies

Optimising anesthesia support during operations on the abdominal aorta and its branches

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