Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

Zangrillo, Alberto; Ломиворотов, В. В.; Pasyuga, Vadim; Belletti, Alessandro; Gazivoda, Gordana; Monaco, Fabrizio; Neto, Caetano Nigro; Лихванцев, В. В.; Bradić, Nikola; Lozovskiy, Andrey; Lei, Chong; Bukamal, Nazar; Silva, Fernanda Santos; Баутин, А. Е.; Ma, Jun; Yong, Chow Yen; Carollo, Cristiana; Kunstýř, Jan; Wang, Chew Yin; Grigoryev, Evgeny; Říha, Hynek; Wang, Chengbin; El-Tahan, Mohamed R.; Scandroglio, Anna Mara; Mansor, Marzida; Lembo, Rosalba; Ponomarev, Dmitry; Bezerra, Francisco José Lucena; Ruggeri, Laura; Chernyavskiy, Alexander; Xu, Junmei; Тарасов, Д Г; Navalesi, Paolo; Yavorovskiy, Andrey; Bove, Tiziana; Kuzovlev, Аrtem; Hajjar, Ludhmila Abrahão; Landoni, Giovanni

doi:10.1053/j.jvca.2022.01.001

Cited by 13 publications

(8 citation statements)

References 47 publications

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“…[10][11][12][13] Recently, the MYRIAD Study Group found that volatile anesthetics may reduce the risk of myocardial infarction and cardiac mortality (cardiogenic shock and arrhythmias) at 1 year in patients undergoing elective, isolated CABG surgery. 29 However, the neuroprotective effects of volatile agents remain unclear, especially the effect on delirium. In addition, previous research in delirium primarily focused on CABG.…”

Section: Discussionmentioning

confidence: 99%

Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial

Jiang

Zhang

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND:The effect of anesthesia regimens on postoperative delirium after on-pump cardiac valve surgery is yet undetermined. This study aimed to evaluate the effect of volatile anesthesia compared with propofol-based total intravenous anesthesia (TIVA) on the occurrence of delirium after on-pump cardiac valve surgery. METHODS: This randomized clinical trial was conducted at a university academic hospital in China, from February 2019 to January 2021. Patients scheduled for on-pump cardiac valve surgery or combined valve with coronary artery bypass grafting (CABG) surgeries were randomly assigned to receive anesthesia maintenance with either a volatile anesthetic (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was the incidence of delirium during the first 7 days after surgery, assessed using the confusion assessment method for the intensive care unit (ICU). The secondary outcomes included duration of delirium, subtypes of delirium, 30-day mortality, pain score, major morbidity (including cerebral infarction, respiratory failure, and pneumonia), duration of mechanical ventilation, and lengths of ICU and hospital stay. The statistical analysis of the primary outcome variable was by Pearson's χ 2 test. RESULTS: Among the 684 patients analyzed (mean age, 53.8 years; 381 [55.7%] women), 676 were assessed for the primary outcome. Postoperative delirium occurred in 63 of 337 (18.7%) patients receiving volatile anesthesia versus 76 of 339 (22.4%) patients receiving propofolbased TIVA (relative risk, 0.80; 95% confidence interval [CI], 0.55-1.16; P = .231). There were no significant differences between the groups in any of the secondary outcomes. CONCLUSIONS: Among patients undergoing on-pump cardiac valve surgery, anesthesia maintenance with a volatile agent did not result in significantly fewer occurrences of postoperative delirium than propofol-based TIVA. (Anesth Analg 2023;136:60-9) KEY POINTS• Question: Dose volatile anesthesia reduces the occurrence of delirium after on-pump cardiac valve surgery when compared with intravenous anesthesia? • Findings: Compared with propofol-based intravenous anesthesia, anesthesia maintenance with a volatile agent did not result in fewer cases of postoperative delirium in patients undergoing on-pump cardiac valve surgery. • Meaning: Our data did not provide sufficient evidence that the choice of volatile or intravenous anesthesia affects the risk of developing delirium after on-pump cardiac valve surgery.

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Section: Discussionmentioning

confidence: 99%

Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial

Jiang

Zhang

et al. 2022

Anesthesia &Amp; Analgesia

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“…Considering that marked fluctuations in arterial blood pressure (mean duration of systolic excursion outside a range of 105-130 mmHg) is a significant predictor of 30-day mortality in patients undergoing CABG [31], the use of VA might be beneficial in reducing patient surgical risk. An anesthetic regimen including volatile agents may also be associated with a lower rate of postoperative MI and hemodynamic complications in patients undergoing CABG [32].…”

Section: Discussionmentioning

confidence: 99%

Volatile versus Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery: Analysis of 1586 MYRIAD Trial Patients Managed with the Same Perioperative Protocol

Ломиворотов¹,

Ruzankin²,

Lembo³

et al. 2022

Rev. Cardiovasc. Med.

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Background: This study investigated the influence of volatile anesthesia (VA) on major complications and mortality in patients undergoing coronary artery bypass graft surgery (CABG). Methods: This post-hoc analysis included 1586 patients from the MYRIAD trial managed using the same perioperative protocol at a single institution. Patients were randomized to receive either volatile anesthesia (sevoflurane, isoflurane, or desflurane) or total intravenous anesthesia (TIVA). The assessed study outcomes were the rate of complications, including: myocardial infarction, stroke, acute kidney injury, prolonged ventilation (>24 h), receipt of high-dose inotropic support (inotropic score >10), and need for mechanical circulatory support. The duration of intensive care unit (ICU) stay, length of hospitalization, hospital readmission during follow-up, 30-days and 1-year mortality were also analyzed. Results: 1586 patients were enrolled between September 2014-September 2017 and randomly assigned to the volatile anesthesia group (n = 794) and the TIVA group (n = 792). The median patient age was 63 years, with a median ejection fraction of 60%. There were no significant differences in the rates of major complications, duration of ICU stay, and hospitalization between the groups. The median total dose of fentanyl was 12.0 mcg/kg in volatile group and 14.4 mcg/kg in TIVA group (p < 0.001). One-year mortality rates were 2.5% (n = 20) and 3.2% (n = 25) in the volatile and TIVA groups, respectively. Two patients were lost at the 30-day and 1-year follow-ups in the volatile group compared to four patients in TIVA group. Regression analysis showed that cardiopulmonary bypass (CPB) duration, fentanyl dose, and baseline serum creatinine level were associated with 30-days mortality, while ejection fraction was associated with 1-year mortality. Conclusions: The use of VA in patients undergoing CABG did not result in a reduction in major complications or mortality compared with TIVA. A higher dose of fentanyl was used in the TIVA group and was associated with an increase in the 30-days mortality. These findings warrant further investigation. Clinical Trial Registration: ClinicalTrials.gov (NCT02105610).

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“…Several modes of administration ranging from single exposure to desflurane for 5 minutes before myocardial ischemia to total inhalation anesthesia have been studied in previous studies. 56,80 Combining the various possible strategies, it seems that the idea proposed by Landoni et al 93 may be promising for clinical application by holding volatile anesthetics for clinical and pretreatment purposes at a minimum level of 1.0 minimum alveolar concentration (MAC) for a minimum of 30 minutes, discontinuing volatile agents for 15 minutes or more before extracorporeal circulation, and going through at least 3 wash-in and wash-out periods when using volatile anesthetics, with the wash-in period being at a minimum of 0.5 MAC for 10 minutes and the wash-out period lasting 10 minutes or longer. These strategies for potentially enhancing the cardioprotective effects of desflurane provide ideas for subsequent clinical studies on cardioprotection.…”

Section: Desflurane In Cabgmentioning

confidence: 99%

“…A study on the effect of anesthetic regimens on postoperative complications of CABG found that volatile anesthetics (desflurane, isoflurane, and sevoflurane) may be associated with lower rates of postoperative myocardial infarction and hemodynamic complications in patients compared with TIVA. 80 Postoperative mechanical ventilation provides essential ventilatory support, but the duration of ventilation is closely related to the chance of patients developing complications such as impaired respiratory function. Zhang et al 64 found that volatile anesthetics, including desflurane, shortened the duration of mechanical ventilation.…”

Section: Desfluranementioning

confidence: 99%

Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical Applications

Han

Jun

2023

Journal of Cardiovascular Pharmacology

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Coronary heart disease (CHD) is an affliction that is common and has an adverse effect on patients' quality of life and survival while also raising the risk of intraoperative anesthesia. Mitochondria are the organelles most closely associated with the pathogenesis, development and prognosis of CHD. Ion abnormalities, an acidic environment, the production of reactive oxygen species, and other changes during abnormal myocardial metabolism cause the opening of mitochondrial permeability transition pores, which disrupts electron transport, impairs mitochondrial function, and even causes cell death. Differences in reliability and cost-effectiveness between desflurane and other volatile anesthetics are minor, but desflurane has shown better myocardial protective benefits in the surgical management of patients with coronary artery disease. The results of myocardial protection by desflurane are briefly summarized in this review, and biological functions of the mitochondrial permeability transition pore, mitochondrial electron transport chain, reactive oxygen species, atp-dependent potassium channels, G protein-coupled receptors, and protein kinase C are discussed in relation to the protective mechanism of desflurane. This article also discusses the effects of desflurane on patient hemodynamics, myocardial function, and postoperative parameters during coronary artery bypass grafting. Although there are limited and insufficient clinical investigations, they do highlight the possible advantages of desflurane and offer additional suggestions for patients.

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Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

Cited by 13 publications

References 47 publications

Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial

Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial

Volatile versus Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery: Analysis of 1586 MYRIAD Trial Patients Managed with the Same Perioperative Protocol

Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical Applications

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