A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia (TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and Meta-Analysis

Objective: The primary objective of this study was to compare one-year mortality in patients undergoing cardiac surgery with volatile anesthesia or total intravenous anesthesia (TIVA). Secondary objectives were to compare in-hospital and 30-day mortality, postoperative levels of creatine kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation, intensive care unit (ICU) and hospital stays. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: International, multi-institution centers. Participants: Adults patients undergoing heart surgery. Interventions: Volatile anesthesia and TIVA. Measurements and Main Results: Meta-analysis found no statistically significant difference between patients receiving TIVA and volatile anesthesia in one-year mortality (n = 6440, OR = 1.22, 95% CI 0.97 to 1.54, p = 0.09, Z = 1.67, I-2 = 0%), troponin (n = 3127, SMD = 0.26, 95% CI-0.01 to 0.52, p = 0.05, Z = 1.92, I-2 = 90%) and CK-MB concentration 24h postoperatively (n = 1214, SMD = 0.10, 95% CI -0.17 to 0.36, unadjusted p = 0.48, Z = 0.71, I-2 = 79%), or time to tracheal extubation (n = 1059, SMD = 0.10, 95% CI -0.28 to 0.49, p = 0.60, Z = 0.53, 12 = 88%). The durations of ICU stay (n = 2003, SMD = 0.29, 95% CI 0.01 to 0.57, p = 0.04, Z = 2.05, I-2 = 88%) and hospital stay (n = 1214, SMD = 0.42, 95% CI 0.10 to 0.75, p = 0.01, Z = 2.53, I-2 = 91%) were shorter in the volatile anesthetic compared to TIVA group. Conclusions: No significant differences in mortality (in-hospital, 30-day, 1-year), troponin and CK-MB concentrations 24 h postoperatively, or time to tracheal extubation were found between patients who had volatile anesthesia or TIVA. Compared to TIVA, volatile anesthesia was associated with shorter durations of hospital and ICU stays. (C) 2020 Elsevier Inc. All rights reserved.