For patients undergoing coronary artery bypass grafting there is no mortality difference between volatile anaesthesia and TIVA.

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• Yi-Nan Zhang, Lei Yang, Wen-Sheng Zhang, and Jin Liu.
• Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
• Minerva Anestesiol. 2020 Oct 1; 86 (10): 106510781065-1078.

IntroductionIt remains unclear whether intraoperative use of volatile anesthetics has a positive effect on postoperative clinical outcomes in patients undergoing coronary artery bypass grafting (CABG). Therefore, we aimed to systematically analyze the long- and short-term mortality rates and the clinical outcomes of volatile anesthesia compared to those of total intravenous anesthesia (TIVA) in patients undergoing CABG.Evidence AcquisitionWe queried the MEDLINE, Embase, and CENTRAL databases from inception to October 2019 for relevant randomized clinical trials (RCTs) on the intraoperative use of volatile anesthetics in patients undergoing CABG.Evidence SynthesisWe pooled and analyzed 36 eligible RCTs with 10,308 patients and found that there was no significant difference in the long- and short-term mortality rate between the use of volatile anesthesia and TIVA during CABG. 30-day mortality, volatile group (39/2,824, 1.4%) vs. TIVA group (35/2,786, 1.3%), RR=1.11, 95% CI [0.70, 1.74], P value for effect =0.66, I2=0%, moderate-certainty evidence; One-year mortality, volatile group (77/2,749, 2.8%) vs. TIVA group (78/2,731, 2.9%), RR=0.98, 95% CI [0.72, 1.34], P value for effect =0.90, I2=0%, moderate-certainty evidence. Mechanical ventilation time was reduced in volatile group (MD -0.65, 95% CI [-1.07, -0.24], P value for effect =0.002, I2=26%).ConclusionsThere is no difference in the long- and short-term mortality and clinical outcomes between intraoperative use of volatile anesthetics and TIVA during CABG. However, volatile anesthetics may shorten the mechanical ventilation time. There is a need for high-quality multicenter RCTs that specifically assess factors that influence mortality and clinical outcomes.

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