Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
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DOI：
10.1056/nejmoa1816476
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发表时间：
2019-03-28
影响因子：
158.5
通讯作者：
Zangrillo, Alberto
中科院分区：
文献类型：
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作者：
Landoni, Giovanni;Lomivorotov, Vladimir V.;Zangrillo, Alberto
背景挥发性（吸入）麻醉剂具有心脏保护作用，可能会改善接受冠状动脉旁路移植术（CABG）的患者的临床结果。方法我们在13个国家的36个中心进行了一项务实的、多中心、单盲、对照试验。计划接受选择性 CABG 的患者被随机分配接受术中麻醉方案，其中包括挥发性麻醉剂（地氟烷、异氟烷或七氟烷）或全静脉麻醉。主要结局是 1 年时全因死亡。 结果 总共 5400 名患者被随机分配：2709 名被分配到挥发性麻醉药组，2691 名被分配到全静脉麻醉组。 64% 的患者进行了体外循环 CABG，体外循环的平均持续时间为 79 分钟。两组在基线人口统计学和临床特征、体外循环持续时间和移植物数量方面相似。在进行第二次中期分析时，数据和安全监测委员会建议因无效而停止试验。 1 年时，各组之间的全因死亡率没有显着差异（挥发性麻醉药组为 2.8%，全静脉麻醉组为 3.0%；相对风险为 0.94；95% 置信区间 [CI]，0.69 至 1.29；P=0.71），数据来自 5353 名患者 (99.1%)，或 30 天时 (1.4%)和 1.3%，分别；相对风险，1.11；95% CI，0.70 至 1.76），有 5398 名患者的数据（99.9%）。各组之间在任何次要结局或包括心肌梗塞在内的预先指定不良事件的发生率方面均无显着差异。结论在接受择期 CABG 的患者中，使用挥发性麻醉剂麻醉并没有导致 1 年死亡率显着低于全静脉麻醉。
BACKGROUNDVolatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).METHODSWe conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.RESULTSA 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.CONCLUSIONSAmong patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.