| Title: | Volatile versus total intravenous anesthesia for 30-day mortality following non-cardiac surgery in patients with preoperative myocardial injury |
| Author(s): | Park J; Lee SH; Lee JH; Min JJ; Kwon JH; Oh AR; Carriere K; Ahn J; |
| Address: | "Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada" |
| DOI: | 10.1371/journal.pone.0238661 |
| ISSN/ISBN: | 1932-6203 (Electronic) 1932-6203 (Linking) |
| Abstract: | "We evaluated whether volatile anesthetics can improve the postoperative outcomes of non-cardiac surgery in patients with preoperative myocardial injury defined by the cardiac troponin elevation. From January 2010 to June 2018, 1254 adult patients with preoperative myocardial injury underwent non-cardiac surgery under general anesthesia and were enrolled in this study. Patients were stratified into following two groups according to anesthetic agents; 115 (9.2%) patients whose anesthesia was induced and maintained with continuous infusion of propofol and remifentanil (TIVA group) and 1139 (90.8%) patients whose anesthesia was maintainted with volatile anesthetics (VOLATILE group). The primary outcome was 30-day mortality. To diminish the remifentanil effect, a further analysis was conducted after excluding the patients who received only volatile anesthetics without remifentanil infusion. In a propensity-score matched analysis, 30-day mortality was higher in the TIVA group than the VOLATILE group (17.0% vs. 9.1%; hazard ratio [HR] 2.60; 95% confidence interval [CI], 1.14-5.93; p = 0.02). In addition, the TIVA group showed higher 30-day mortality than the VOLATILE group, even after eliminating the effect of remifentanil infusion (15.8% vs. 8.3%; HR 4.62; 95% CI, 1.82-11.74; p = 0.001). In our study, the use of volatile anesthetics showed the significant survival improvement after non-cardiac surgery in patients with preoperative myocardial injury, which appears to be irrelevant to the remifentanil use. Further studies are needed to confirm this beneficial effect of volatile anesthetics. Clinical trial number and registry URL: KCT0004349 (www.cris.nih.go.kr)" |
| Keywords: | "Adolescent Adult Aged Aged, 80 and over Anesthesia, General/adverse effects Anesthesia, Intravenous/*adverse effects Female Heart Injuries/blood/chemically induced/*mortality/physiopathology Humans Kidney/physiopathology/surgery Male Middle Aged Myocardiu;" |
| Notes: | "MedlinePark, Jungchan Lee, Seung-Hwa Lee, Jong-Hwan Min, Jeong Jin Kwon, Ji-Hye Oh, Ah-Ran Carriere, Keumhee Ahn, Joonghyun eng Clinical Trial 2020/09/12 PLoS One. 2020 Sep 11; 15(9):e0238661. doi: 10.1371/journal.pone.0238661. eCollection 2020" |
