Landoni G, et al. - Researchers investigated whether volatile (inhaled) anesthetic agents improved clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG), owing to cardioprotective effects of these agents. They found that the reported number of deaths at 1 year among patients who received anesthesia with a volatile agent for elective CABG was not significantly fewer when compared to those who received total intravenous anesthesia for the same procedure.

Methods

• This is a pragmatic, multicenter, single-blind, controlled trial.
• This trial was conducted at 36 centers in 13 countries and included patients scheduled to undergo elective CABG.
• Researchers randomly administered an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia to the participants.
• They assessed death from any cause at 1 year (primary outcome).

Results

• This study included 5400 patients: 2709 received volatile anesthetics and 2691 received total intravenous anesthesia.
• Overall 64% of patients underwent on-pump CABG, with a mean duration of cardiopulmonary bypass of 79 minutes.
• Demographic and clinical features at baseline, the duration of cardiopulmonary bypass, and the number of grafts were similar between the two groups.
• The recommendation by data and safety monitoring board at the time of the second interim analysis was that the trial should be stopped for futility.
• In terms of deaths from any cause, both the groups demonstrated no significant difference at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%).
• Both the groups did not differ remarkably with respect to any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.