科研之友
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摘要
Many studies have compared desflurane, isoflurane, sevoflurane, total i.v. anaesthesia (TIVA), or all in cardiac surgery to assess their effects on patient survival. %26lt;br%26gt;We performed standard pairwise and Bayesian network meta-analyses; the latter allows indirect assessments if any of the anaesthetic agents were not compared in head-to-head trials. Pertinent studies were identified using BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Library (last updated in June 2012). %26lt;br%26gt;We identified 38 randomized trials with survival data published between 1991 and 2012, with most studies (63) done in coronary artery bypass grafting (CABG) patients with standard cardiopulmonary bypass. Standard meta-analysis showed that the use of a volatile agent was associated with a reduction in mortality when compared with TIVA at the longest follow-up available [25/1994 (1.3) in the volatile group vs 43/1648 (2.6) in the TIVA arm, odds ratio (OR)0.51, 95 confidence interval (CI) 0.330.81, P-value for effect0.004, number needed to treat 74, I(2)0] with results confirmed in trials with low risk of bias, in large trials, and when including only CABG studies. Bayesian network meta-analysis showed that sevoflurane (OR0.31, 95 credible interval 0.140.64) and desflurane (OR0.43, 95 credible interval 0.210.82) were individually associated with a reduction in mortality when compared with TIVA. %26lt;br%26gt;Anaesthesia with volatile agents appears to reduce mortality after cardiac surgery when compared with TIVA, especially when sevoflurane or desflurane is used. A large, multicentre trial is warranted to confirm that long-term survival is significantly affected by the choice of anaesthetic.
- 出版日期2013-12
