Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Oct 11;7(10):e014629.
doi: 10.1136/bmjopen-2016-014629.

Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis

Feng Chen  1 , Guangyou Duan  1 , Zhuoxi Wu  1 , Zhiyi Zuo  2 , Hong Li  1
Affiliations
Meta-Analysis

Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis

Feng Chen et al. BMJ Open. .

Abstract

Objective: Neurological dysfunction remains a devastating postoperative complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and previous studies have shown that inhalation anaesthesia and total intravenous anaesthesia (TIVA) may produce different degrees of cerebral protection in these patients. Therefore, we conducted a systematic literature review and meta-analysis to compare the neuroprotective effects of inhalation anaesthesia and TIVA.

Design: Searching in PubMed, EMBASE, Science Direct/Elsevier, China National Knowledge Infrastructure and Cochrane Library up to August 2016, we selected related randomised controlled trials for this meta-analysis.

Results: A total of 1485 studies were identified. After eliminating duplicate articles and screening titles and abstracts, 445 studies were potentially eligible. After applying exclusion criteria (full texts reported as abstracts, review article, no control case, lack of outcome data and so on), 13 studies were selected for review. Our results demonstrated that the primary outcome related to S100B level in the inhalation anaesthesia group was significantly lower than in the TIVA group after CPB and 24 hours postoperatively (weighted mean difference (WMD); 95% CI (CI): -0.41(-0.81 to -0.01), -0.32 (-0.59 to -0.05), respectively). Among secondary outcome variables, mini-mental state examination scores of the inhalation anaesthesia group were significantly higher than those of the TIVA group 24 hours after operation (WMD (95% CI): 1.87 (0.82 to 2.92)), but no significant difference was found in arteriovenous oxygen content difference, cerebral oxygen extraction ratio and jugular bulb venous oxygen saturation, which were assessed at cooling and rewarming during CPB.

Conclusion: This study demonstrates that anaesthesia with volatile agents appears to provide better cerebral protection than TIVA for patients undergoing cardiac surgery with CPB, suggesting that inhalation anaesthesia may be more suitable for patients undergoing cardiac surgery.

Keywords: anaesthesia; cardiac surgery; cardiopulmonary bypass.; cerebral protection.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram for the selection of eligible studies.
Figure 2
Figure 2
Forest plot showing the meta-analysis outcomes of the difference in S100B levels of inhalation anaesthesia and TIVA groups. TIVA, total intravenous anaesthesia.
Figure 3
Figure 3
Forest plot showing the meta-analysis outcomes of the difference in MMSE scores of inhalation anaesthesia and TIVA groups. MMSE, mini-mental state examination; TIVA, total intravenous anaesthesia.
Figure 4
Figure 4
Forest plot showing the meta-analysis outcomes of the difference in D(a-v)O2 of inhalation anaesthesia and TIVA groups. D(a-v)O2, arteriovenous oxygen content difference; TIVA, total intravenous anaesthesia.
Figure 5
Figure 5
Forest plot showing the meta-analysis outcomes of the difference in SjvO2 of inhalation anaesthesia and TIVA groups. SjvO2, jugular bulb venous oxygen saturation, TIVA, total intravenous anaesthesia.
Figure 6
Figure 6
Forest plot showing the meta-analysis outcomes of the difference in cerebral O2ER of inhalation anaesthesia and TIVA groups. O2ER, oxygen extraction ratio; TIVA, total intravenous anaesthesia.
Figure 7
Figure 7
The plot of sensitivity analysis of S100B levels.
Figure 8
Figure 8
The plot of sensitivity analysis of MMSE scores. MMSE, mini-mental state examination.
See this image and copyright information in PMC

References

    1. Lamy A, Devereaux PJ, Prabhakaran D, et al. . Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013;368:1179–88. 10.1056/NEJMoa1301228 - DOI - PubMed
    1. Lamy A, Devereaux PJ, Prabhakaran D, et al. . Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med 2016;375:2359–68. 10.1056/NEJMoa1601564 - DOI - PubMed
    1. McKhann GM, Grega MA, Borowicz LM, et al. . Stroke and encephalopathy after cardiac surgery: an update. Stroke 2006;37:562–71. 10.1161/01.STR.0000199032.78782.6c - DOI - PubMed
    1. Hogue CW, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth Analg 2006;103:21–37. 10.1213/01.ANE.0000220035.82989.79 - DOI - PubMed
    1. Wimmer-Greinecker G, Matheis G, Brieden M, et al. . Neuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting. Thorac Cardiovasc Surg 1998;46:207–12. 10.1055/s-2007-1010226 - DOI - PubMed

MeSH terms