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Profundidad de la anestesia y complicaciones después de una cirugía mayor: un ensayo internacional controlado
Timothy G Short1, Douglas Campbell1, Christopher Frampton2
1Auckland City Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand.
Lancet (London, England)
|October 25, 2019
Resumen
La anestesia general ligera no redujo la mortalidad a 1 año en comparación con la anestesia general profunda en pacientes quirúrgicos mayores. Este estudio proporciona evidencia sobre los rangos de profundidad anestésica seguros para la cirugía mayor.
Área de la Ciencia:
- Anestesiología y medicina de cuidados intensivos
- Resultados quirúrgicos y seguridad del paciente
- Medicina para la edad avanzada
Sus antecedentes:
- Los estudios de observación sugieren un vínculo entre la anestesia más profunda y la supervivencia postoperatoria reducida.
- La evidencia de ensayos controlados aleatorios que comparan diferentes profundidades de anestesia con respecto a la mortalidad es limitada.
- Este estudio aborda la falta de evidencia de alta calidad sobre la profundidad de la anestesia y los resultados del paciente.
Objetivo del estudio:
- Para comparar la mortalidad por cualquier causa a 1 año en pacientes mayores sometidos a cirugía mayor.
- Evaluar la seguridad y eficacia de la anestesia general ligera frente a la anestesia general profunda.
- Determinar el impacto de los objetivos del índice bispectral (BIS) en la supervivencia del paciente.
Principales métodos:
- Ensayos controlados aleatorios internacionales en los que participaron 6644 pacientes de alto riesgo mayores de 60 años sometidos a cirugía mayor.
- Los pacientes fueron asignados a anestesia general ligera (objetivo BIS 50) o anestesia general profunda (objetivo BIS 35).
- El resultado primario fue la mortalidad por cualquier causa a 1 año, con asignación de pacientes y evaluadores enmascarados.
Principales resultados:
- La mortalidad a 1 año fue del 6,5% en el grupo de anestesia ligera (BIS 50) y del 7,2% en el grupo de anestesia profunda (BIS 35).
- No hubo diferencias significativas en la mortalidad a 1 año entre los dos grupos (razón de riesgo 0,88, IC del 95% 0,73 a 1,07).
- Se observaron tasas similares de eventos adversos de grado 3 y grado 4 en ambos grupos.
Conclusiones:
- La anestesia general ligera no se asoció con una menor mortalidad a 1 año en comparación con la anestesia general profunda en esta población de pacientes.
- Los hallazgos sugieren que un amplio rango de profundidad anestésica puede administrarse de manera segura utilizando un monitoreo electroencefalográfico procesado.
- Este ensayo aporta datos valiosos para optimizar el manejo de la anestesia en pacientes quirúrgicos de alto riesgo.
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