• Christopher Uhlig, Thomas Bluth, Kristin Schwarz, Stefanie Deckert, Luise Heinrich, Stefan De Hert, Giovanni Landoni, Ary Serpa Neto, Marcus J Schultz, Paolo Pelosi, Jochen Schmitt, and Marcelo Gama de Abreu.
• From the Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany (C.U., T.B., M.G.d.A.); Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany (C.U.); Center for Evidence-Based Healthcare, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany (K.S., S.D., L.H., J.S.); Department of Anesthesiology, Ghent University Hospital, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (S.D.H.); Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy (G.L.); Department of Critical Care Medicine, Hospital Israelita Albert Einstein, and Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil (A.S.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (M.J.S.); and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy (P.P.).
• Anesthesiology. 2016 Jun 1; 124 (6): 1230-45.

BackgroundIt is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery.MethodsA systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods.ResultsSixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092).ConclusionsIn cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery.

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