The Anesthesia in Abdominal Aortic Surgery (ABSENT) Study

Lindholm, Espen; Aune, Erlend; Norén, Camilla B.; Seljeflot, Ingebjørg; Hayes, T.B.J.; Otterstad, Jan Erik; Kirkebøen, Knut Arvid

doi:10.1097/aln.0b013e31829bd883

Cited by 44 publications

(11 citation statements)

References 49 publications

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“…Long duration (more than 4 h) of sevoflurane inhalation did not provide clinically detectable myocardial protection in elderly patients with CHD in this study. These results are similar to the previous studies [ 15 , 16 ]. RCT which included 385 cases in Switzerland found that, propofol and sevoflurane had no difference in postoperative delirium, myocardial ischemia, and major adverse cardiac events during 1 year follow-up [ 15 ].…”

Section: Discussionsupporting

confidence: 93%

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

et al. 2017

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BackgroundIt is skeptical about cardioprotective property of sevoflurane in patients undergoing noncardiac surgery, especially in the elderly patients with coronary heart disease. We hypothesized that long duration of sevoflurane inhalation in noncardiac surgery could ameliorate myocardial damage in such patients.MethodsThis was a randomized, prospective study. One hundred twenty-one elderly patients with coronary heart disease were randomly allocated into two groups. Maintenance of anesthesia was achieved by sevoflurane inhalation (Group S) or propofol-remifentanil respectively (Group PR). Serum cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) were measured before anesthesia induction (T0), 8 h (T1) and 24 h (T2) after anesthesia respectively. The perioperative cardiac output, complications and postoperative 3-month follow-up from end of surgery were recorded.ResultsBetween the two groups, there were no statistical differences in the values of cTnI and BNP during the study. However, The area under the curve of cTnI values over 24 h after operation was less in Group S. Group PR had lower cardiac output and consumed more amount of phenylephrine during the study (P < 0.05).ConclusionsCompared with the group PR, sevoflurane had no benefit in the myocardial protection for the elderly patients with CHD. However, Sevoflurane showed advantage in maintaining hemodynamic stability during the operative period.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16008871, 21 July 2016.

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Section: Discussionsupporting

confidence: 93%

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

et al. 2017

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“…In the most recent randomized study, enrolling 200 patients, Landoni et al did not find a difference between patients anesthetized with sevoflurane or propofol in postoperative cardiac troponin release, 1-year all-cause mortality, rehospitalizations, and adverse cardiac events [ 90 ]. In major vascular surgery, Lurati-Buse et al, Lindholm et al, and Zangrillo et al all failed to show beneficial effects of a sevoflurane-based anesthesia regimen compared with TIVA [ 91 – 93 ].…”

Section: Emerging Topics In Inhalation Anesthesiamentioning

confidence: 99%

A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics

et al. 2017

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A large number of studies during the past two decades have demonstrated the efficacy and safety of sevoflurane across patient populations. Clinical researchers have also investigated the effects of sevoflurane, its hemodynamic characteristics, its potential protective effects on several organ systems, and the incidence of delirium and cognitive deficiency. This review examines the clinical profiles of sevoflurane and other anesthetic agents, and focuses upon emerging topics such as organ protection, postoperative cognitive deficiency and delirium, and novel ways to improve postanesthesia outcomes.

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“…However, considering the accumulating evidence indicating the lack of significant benefits of choosing volatile anesthetics over propofol during noncardiac surgery [16,21,[37][38][39], the 2014 ACC/AHA guidelines thus revised the recommendations regarding the choice of anesthetics for noncardiac surgery [26]. Subsequent randomized trials comparing TIVA with sevoflurane also reported no difference in their primary outcomes related to myocardial injury [22,40].…”

Section: Discussionmentioning

confidence: 99%

“…Since cardiovascular complication after surgery involves sympathetic activation, hypercoagulability, arterial thrombosis, and inflammation [17][18][19], the choice of anesthetics has potential to affect the incidence of MACCE after noncardiac surgery in patients with a history of coronary stent insertion. Previous animal studies have demonstrated that volatile anesthetics could reduce the size of myocardial infarction [11,12]; however, clinical studies have reported conflicting results about their effects in patients undergoing noncardiac surgery [20][21][22]. A recent large international randomized trial revealed that volatile anesthetics in cardiac surgical patients did not provide significant cardioprotection compared with total intravenous anesthesia (TIVA) [23].…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

Yoon¹,

Jun²,

Park³

et al. 2020

JCM

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Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, p = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; p = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92–2.37, p = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.

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The Anesthesia in Abdominal Aortic Surgery (ABSENT) Study

Cited by 44 publications

References 49 publications

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics

Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

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