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The effect of isoflurane on survival and myocardial infarction: a meta-analysis of randomized controlled studies
Elena Bignami1, Teresa Greco, Luigi Barile
1Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
Insights
This meta-analysis found isoflurane did not significantly reduce mortality or myocardial infarction rates. However, high-quality studies indicated isoflurane may reduce mortality, with a trend observed when compared to propofol.
Area of Science:
- Anesthesiology
- Cardiology
- Critical Care Medicine
Background:
- The cardioprotective effects of anesthetic agents are crucial for patient outcomes.
- Isoflurane is a widely used inhalation anesthetic.
- Understanding its impact on myocardial infarction and mortality is essential.
Purpose of the Study:
- To evaluate the cardioprotective properties of isoflurane compared to other anesthetic agents.
- To assess the impact of isoflurane on myocardial infarction and all-cause mortality rates.
Main Methods:
- A meta-analysis of 37 randomized controlled trials involving 3,539 patients.
- Studies were identified through comprehensive searches of major medical databases.
- Primary endpoint was all-cause mortality at the longest available follow-up.
Main Results:
- Overall analysis of 37 trials showed no significant difference in mortality (OR=0.76) or myocardial infarction (OR=2.03) between isoflurane and control groups.
- However, in high-quality studies (low risk of bias), isoflurane significantly reduced mortality (OR=0.13).
- A trend towards reduced mortality was observed when isoflurane was compared with propofol (p=0.05).
Conclusions:
- Isoflurane demonstrated a mortality-reducing effect in high-quality studies.
- A trend suggests potential benefits when isoflurane is compared with propofol.
- No overall significant differences in myocardial infarction or mortality were found in the general analysis.
Objective:
The aim of this meta-analysis was to investigate the cardioprotective properties of isoflurane versus any comparator in terms of the rate of myocardial infarction and all-cause mortality.
Design:
Pertinent studies were searched independently in Biomed, Central, PubMed, Embase, and the Cochrane Central Register of clinical trials. The primary endpoint was mortality at the longest follow-up available.
Setting:
A hospital.
Participants:
Randomized controlled trials.
Intervention:
A meta-analysis of 37 trials.
Measurements And Main Results:
The 37 included trials randomized 3,539 patients in cardiac (16 studies) and in noncardiac surgery (21 studies) with noninhalation comparators in 55% of trials. The overall analysis showed no difference in mortality between the isoflurane and control groups (16/1,602 [1.0%] v 23/1,937 [1.2%], odds ratios (OR) = 0.76 [0.39-1.47], p = 0.4 with 37 studies included) and no difference in the rate of myocardial infarction (3/1,312 [0.2%] v 1/1,532 [0.07%], OR = 2.03 [0.27-15.49], p = 0.5 with 30 studies included). Mortality was reduced in the isoflurane group when only studies with a low risk of bias were included in the analyses (0/540 [0%] v 5/703 [0.7%] in the control arm, OR = 0.13 [0.02-0.76], p = 0.02) with 4 cardiac and 6 noncardiac trials included and 5 noninhalation and 5 inhalation agents as the comparator. A trend was noted when a subanalysis was performed with propofol as a comparator (1/544 [0.2%] v 6/546 [1.1%], p = 0.05, with 16 studies included).
Conclusions:
Isoflurane reduced mortality in high-quality studies and showed a trend toward a reduction in mortality when it was compared with propofol. No differences in the rates of overall mortality and myocardial infarction were noted.
