Key result
Sevoflurane was associated with a lower incidence of myocardial ischemia compared to propofol in patients undergoing CABG surgery (OR 0.37; 95% CI 0.16-0.83; P=0.02).
Why the study?
Does sevoflurane improve myocardial protection compared to propofol in adult patients undergoing CABG surgery?
Meta-Analysis (n=696)
Does sevoflurane improve myocardial protection compared to propofol in adult patients undergoing CABG surgery?
Odds Ratio: 0.37 (95% CI 0.16–0.83)
p-value: p=0.02
Sevoflurane provides better perioperative myocardial protection than propofol in patients undergoing CABG surgery, as evidenced by improved cardiac index and lower troponin I levels, though hard clinical outcomes like mortality and MI did not differ significantly.
Sevoflurane may be preferred over propofol to lower ischemia risk in CABG; reinforces meta-analytic signals but leaves hard outcomes unresolved.
OBJECTIVE: To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. METHODS: Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P<0.05. RESULTS: Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P>0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI: -0.87 to -0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI: -12.97 to -9.01, P<0.00001; WMD=-0.78, 95% CI: -1.00 to -0.56, P<0.00001, respectively). CONCLUSION: This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.
No takes yet. Share an insight, caveat, or question.
Yao et al. (2009) conducted a meta-analysis in Coronary artery bypass grafting (CABG) surgery (n=696). Sevoflurane vs. Propofol was evaluated on Incidence of myocardial ischemia (OR 0.37, 95% CI 0.16 to 0.83, p=0.02). Sevoflurane was associated with a lower incidence of myocardial ischemia compared to propofol in patients undergoing CABG surgery (OR 0.37; 95% CI 0.16-0.83; P=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: