This is just one study. There are numerous studies looking at post CPB, the majority showing less pressor needed and less troponin rise postop. I think it is unequivocal that for CPB a volatile should be used, because there is a known ischemic insult.
For non CPB cases, there should be no ischemic insult. As far as I remember there aren’t any studies showing a benefit in non cardiac surgery.
I use volatile for CPB cases. The four institutions I've trained and work at all use volatile. Every cardiac anesthesiologist I know uses volatile. That still doesn't justify using the terminology that it's
unequivocal that for CPB a volatile must be used.
Bench research studies on ischemic preconditioning, troponin leak, and pressor requirement have not translated to a (large majority of studies showing a) difference in weaning from CPB failure, intubation duration, ICU length of stay, reinfarct rates, or mortality. Again, I don't disagree with using volatile 100% of the time for pump cases, but I wouldn't necessarily go around saying that the debate is settled when multiple large studies (including MYRIAD, listed below, which was just published in NEJM, and I believe the one UTDOL was referring to- not the one I first quoted) and metanalyses can't demonstrate as such.
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RESULTS
A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.
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CONCLUSIONS:
In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery.
In the authors' experience, patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics. Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery.
www.ncbi.nlm.nih.gov
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CONCLUSIONS:
Anesthesia with sevoflurane reduced cardiac biomarker release and length of hospital stay after CABG with cardiopulmonary bypass surgery compared with propofol-based TIVA with a possible reduction in 1-year mortality.
Anesthesia with sevoflurane reduced cardiac biomarker release and length of hospital stay after CABG with cardiopulmonary bypass surgery compared with propofol-based TIVA with a possible reduction in 1-year mortality.
www.ncbi.nlm.nih.gov
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CONCLUSION:
This meta-analysis demonstrates sevoflurane and desflurane reduce the postoperative rise in cTnI. Sevoflurane-mediated reduction in cardiac troponin was associated with improved long-term outcomes in one study. This meta-analysis was not able to show that these positive effects on troponin were translated into improved clinical outcomes. Well-designed large randomized control trials are needed to further elucidate the differential cardio-protective effects of volatile anesthetics.
This meta-analysis demonstrates sevoflurane and desflurane reduce the postoperative rise in cTnI. Sevoflurane-mediated reduction in cardiac troponin was associated with improved long-term outcomes in one study. This meta-analysis was not able to show that these positive effects on troponin were...
www.ncbi.nlm.nih.gov