Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery

Feng Li, Yuan Yuan, Feng Li, Yuan Yuan

Abstract

Background: To evaluate the cardioprotective effects of sevoflurane versus propofol anesthesia in patients undergoing cardiac surgery.

Methods: Studies were retrieved through searching several databases. Study quality was evaluated by Jadad scale. Meta-analysis was performed with RevMan5.0 software. Publication bias was tested by funnel plot.

Results: As a result, 15 studies were included. Compared with propofol, sevoflurane anesthesia significantly improved postoperative (WMD (weighted mean difference) = 0.62, 95% CI: 0.33 to 0.92; P < 0.0001) and postoperative 12 hour cardiac index (WMD = 0.18, 95% CI: 0.03 to 0.33; P = 0.02), postoperative cardiac output (WMD = 1.14, 95% CI: 0.74 to 1.54; P < 0.00001), and reduced postoperative 24 hour cardiac troponin I concentration (WMD = -0.86, 95% CI:-1.49 to -0.22; P = 0.008), postoperative inotropic drug usage (OR (odds ratio) = 0.31, 95% CI: 0.22 to 0.44; P < 0.00001), vasoconstrictor drug usage (OR = 0.30, 95% CI:0.21 to 0.43; P < 0.00001), ICU stay (WMD = -15.53, 95% CI: -24.29 to -6.58; P = 0.0007) and a trial fibrillation incidence (OR = 0.25, 95% CI: 0.07 to 0.85; P = 0.03). However, no significant differences were found in other indexes. Subgroup analysis indicated the similar results.

Discussion: The sevoflurane-induced cTnI reduction is associated with lower incidence of late adverse cardiac events, accounting for its roles in cardiac protection. Several limitations existed such as the small sample size and the lack use of blind design.

Conclusions: Sevoflurane may exhibit a more favorable cardioprotective effect during cardiac surgery than propofol.

Figures

Fig. 1
Fig. 1
Flow chart of literature selection
Fig. 2
Fig. 2
Forest plots of the postoperative cardiac index (a) and postoperative 12-h cardiac index (b). Sevoflurane and propofol groups were compared
Fig. 3
Fig. 3
Forest plots of postoperative cardiac output (a) and postoperative 12-h cardiac output (b). Sevoflurane and propofol groups were compared
Fig. 4
Fig. 4
Forest plot showing comparison of postoperative 24-h cTnI between the sevoflurane and propofol groups
Fig. 5
Fig. 5
Forest plot showing comparison of mechanical ventilation time between the sevoflurane and propofol groups
Fig. 6
Fig. 6
Forest plot of postoperative inotropic drug use (a). Forest plot of inotropic drug use during the ICU stay (b). Forest plot of postoperative vasoconstrictor drug use (c). Forest plot of vasoconstrictor drug use during ICU stay (d). Sevoflurane and propofol groups were compared
Fig. 7
Fig. 7
Forest plots of postoperative ICU length of stay (a) and hospital length of stay (b). Sevoflurane and propofol groups were compared
Fig. 8
Fig. 8
Forest plots of the incidence of postoperative myocardial infarction (a). Forest plot of atrial fibrillation (b). Forest plot of mortality (c). Sevoflurane and propofol groups were compared
Fig. 9
Fig. 9
Publication bias analysis according to a funnel plot for postoperative mortality

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