Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis

Feng Chen, Guangyou Duan, Zhuoxi Wu, Zhiyi Zuo, Hong Li, Feng Chen, Guangyou Duan, Zhuoxi Wu, Zhiyi Zuo, Hong Li

Abstract

Objective: Neurological dysfunction remains a devastating postoperative complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and previous studies have shown that inhalation anaesthesia and total intravenous anaesthesia (TIVA) may produce different degrees of cerebral protection in these patients. Therefore, we conducted a systematic literature review and meta-analysis to compare the neuroprotective effects of inhalation anaesthesia and TIVA.

Design: Searching in PubMed, EMBASE, Science Direct/Elsevier, China National Knowledge Infrastructure and Cochrane Library up to August 2016, we selected related randomised controlled trials for this meta-analysis.

Results: A total of 1485 studies were identified. After eliminating duplicate articles and screening titles and abstracts, 445 studies were potentially eligible. After applying exclusion criteria (full texts reported as abstracts, review article, no control case, lack of outcome data and so on), 13 studies were selected for review. Our results demonstrated that the primary outcome related to S100B level in the inhalation anaesthesia group was significantly lower than in the TIVA group after CPB and 24 hours postoperatively (weighted mean difference (WMD); 95% CI (CI): -0.41(-0.81 to -0.01), -0.32 (-0.59 to -0.05), respectively). Among secondary outcome variables, mini-mental state examination scores of the inhalation anaesthesia group were significantly higher than those of the TIVA group 24 hours after operation (WMD (95% CI): 1.87 (0.82 to 2.92)), but no significant difference was found in arteriovenous oxygen content difference, cerebral oxygen extraction ratio and jugular bulb venous oxygen saturation, which were assessed at cooling and rewarming during CPB.

Conclusion: This study demonstrates that anaesthesia with volatile agents appears to provide better cerebral protection than TIVA for patients undergoing cardiac surgery with CPB, suggesting that inhalation anaesthesia may be more suitable for patients undergoing cardiac surgery.

Keywords: anaesthesia; cardiac surgery; cardiopulmonary bypass.; cerebral protection.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Flow diagram for the selection of eligible studies.
Figure 2
Figure 2
Forest plot showing the meta-analysis outcomes of the difference in S100B levels of inhalation anaesthesia and TIVA groups. TIVA, total intravenous anaesthesia.
Figure 3
Figure 3
Forest plot showing the meta-analysis outcomes of the difference in MMSE scores of inhalation anaesthesia and TIVA groups. MMSE, mini-mental state examination; TIVA, total intravenous anaesthesia.
Figure 4
Figure 4
Forest plot showing the meta-analysis outcomes of the difference in D(a-v)O2 of inhalation anaesthesia and TIVA groups. D(a-v)O2, arteriovenous oxygen content difference; TIVA, total intravenous anaesthesia.
Figure 5
Figure 5
Forest plot showing the meta-analysis outcomes of the difference in SjvO2 of inhalation anaesthesia and TIVA groups. SjvO2, jugular bulb venous oxygen saturation, TIVA, total intravenous anaesthesia.
Figure 6
Figure 6
Forest plot showing the meta-analysis outcomes of the difference in cerebral O2ER of inhalation anaesthesia and TIVA groups. O2ER, oxygen extraction ratio; TIVA, total intravenous anaesthesia.
Figure 7
Figure 7
The plot of sensitivity analysis of S100B levels.
Figure 8
Figure 8
The plot of sensitivity analysis of MMSE scores. MMSE, mini-mental state examination.

References

    1. Lamy A, Devereaux PJ, Prabhakaran D, et al. . Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013;368:1179–88. 10.1056/NEJMoa1301228
    1. Lamy A, Devereaux PJ, Prabhakaran D, et al. . Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med 2016;375:2359–68. 10.1056/NEJMoa1601564
    1. McKhann GM, Grega MA, Borowicz LM, et al. . Stroke and encephalopathy after cardiac surgery: an update. Stroke 2006;37:562–71. 10.1161/01.STR.0000199032.78782.6c
    1. Hogue CW, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth Analg 2006;103:21–37. 10.1213/01.ANE.0000220035.82989.79
    1. Wimmer-Greinecker G, Matheis G, Brieden M, et al. . Neuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting. Thorac Cardiovasc Surg 1998;46:207–12. 10.1055/s-2007-1010226
    1. Blumenthal JA, Mahanna EP, Madden DJ, et al. . Methodological issues in the assessment of neuropsychologic function after cardiac surgery. Ann Thorac Surg 1995;59:1345–50. 10.1016/0003-4975(95)00055-P
    1. Pape M, Engelhard K, Eberspächer E, et al. . The long-term effect of sevoflurane on neuronal cell damage and expression of apoptotic factors after cerebral ischemia and reperfusion in rats. Anesth Analg 2006;103:173–9. 10.1213/01.ane.0000222634.51192.a4
    1. Sakai H, Sheng H, Yates RB, et al. . Isoflurane provides long-term protection against focal cerebral ischemia in the rat. Anesthesiology 2007;106:92–9. 10.1097/00000542-200701000-00017
    1. Selman WR, Spetzler RF, Roessmann UR, et al. . Barbiturate-induced coma therapy for focal cerebral ischemia. Effect after temporary and permanent MCA occlusion. J Neurosurg 1981;55:220–6. 10.3171/jns.1981.55.2.0220
    1. Iwata T, Inoue S, Kawaguchi M, et al. . Comparison of the effects of sevoflurane and propofol on cooling and rewarming during deliberate mild hypothermia for neurosurgery. Br J Anaesth 2003;90:32–8. 10.1093/bja/aeg016
    1. Dabrowski W, Rzecki Z, Czajkowski M, et al. . Volatile anesthetics reduce biochemical markers of brain injury and brain magnesium disorders in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2012;26:395–402. 10.1053/j.jvca.2011.10.014
    1. Sagara Y, Hendler S, Khoh-Reiter S, et al. . Propofol hemisuccinate protects neuronal cells from oxidative injury. J Neurochem 1999;73:2524–30. 10.1046/j.1471-4159.1999.0732524.x
    1. Wang H, Lu S, Yu Q, et al. . Sevoflurane preconditioning confers neuroprotection via anti-inflammatory effects. Front Biosci 2011;3:604–15.
    1. McAuliffe JJ, Loepke AW, Miles L, et al. . Desflurane, isoflurane, and sevoflurane provide limited neuroprotection against neonatal hypoxia-ischemia in a delayed preconditioning paradigm. Anesthesiology 2009;111:533–46. 10.1097/ALN.0b013e3181b060d3
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097 10.1371/journal.pmed.1000097
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–58. 10.1002/sim.1186
    1. Min J, Yanlin B. Target controlled infusion of propofol in shallow perioperative cardiopulmonary bypass for brain protection. Int J Clin Exp Med 2007;4:120–1.
    1. Huaping Y. Two methods of anesthesia of CPB heart valve replacement patients plasma level and the influence of cognitive function according to beta. Shandong Med 2015;55:71–2.
    1. Lei L, Weifu L, Jianchun F, et al. . Effects of different anesthesia on cognition function in geriatric patients following off-pump coronary artery bypass grafting. Chin J Geriatr Heart Brain Vessel Dis 2010;12:1002–4.
    1. Newman MF, Croughwell ND, White WD, et al. . Pharmacologic electroencephalographic suppression during cardiopulmonary bypass: a comparison of thiopental and isoflurane. Anesth Analg 1998;86:246–51.
    1. Woodcock TE, Murkin JM, Farrar JK, et al. . Pharmacologic EEG suppression during cardiopulmonary bypass: cerebral hemodynamic and metabolic effects of thiopental or isoflurane during hypothermia and normothermia. Anesthesiology 1987;67:218–24.
    1. Güçlü ÇY, Ünver S, Aydınlı B, et al. . The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass-randomized trial. Adv Clin Exp Med 2014;23:919–24. 10.17219/acem/37339
    1. Tingting C, Gang W, Qi Z, et al. . The comparison between isoflurane and propofol with effect on cerebral protection in cardiac valve replacement Surgery. Chin J ECC 2007;5:91-93–117.
    1. Jianrong G, Donglin J, Liyuan R, et al. . Isoflurane and propofol for extracorporeal circulation open-heart surgery in patients with a comparative study of perioperative cerebral protection. Chin J Clin Pharmacol Ther 2009;14:812–7.
    1. Shudong M. Propofol and seven halothane Anesthesia for experacorporeal circulation of brain protection effect comparison. Chin & F Med treatment 2015;12:145–6.
    1. Singh SP, Kapoor PM, Chowdhury U, et al. . Comparison of S100β levels, and their correlation with hemodynamic indices in patients undergoing coronary artery bypass grafting with three different anesthetic techniques. Ann Card Anaesth 2011;14:197–202. 10.4103/0971-9784.83998
    1. Kanbak M, Saricaoglu F, Avci A, et al. . Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels. Can J Anaesth 2004;51:712–7. 10.1007/BF03018431
    1. Baki ED, Aldemir M, Kokulu S, et al. . Comparison of the effects of desflurane and propofol anesthesia on the inflammatory response and s100β protein during coronary artery bypass grafting. Inflammation 2013;36:1327–33. 10.1007/s10753-013-9671-6
    1. Jiying Z, Feng X, Xianjie W, et al. . Brain protection of desflurane in old patients undergoing coronary artery bypass grafting. Chin J New Drugs Clin Rem 2010;29:847–9.
    1. Wang DD, Bordey A. The astrocyte odyssey. Prog Neurobiol 2008;86:342–67. 10.1016/j.pneurobio.2008.09.015
    1. An SA, Kim J, Kim OJ, et al. . Limited clinical value of multiple blood markers in the diagnosis of ischemic stroke. Clin Biochem 2013;46:710–5. 10.1016/j.clinbiochem.2013.02.005
    1. Kuzumi E, Vuylsteke A, Guo X, et al. . Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anaesth 2000;85:936–7.
    1. Rasmussen LS, Christiansen M, Eliasen K, et al. . Biochemical markers for brain damage after cardiac surgery - time profile and correlation with cognitive dysfunction. Acta Anaesthesiol Scand 2002;46:547–51. 10.1034/j.1399-6576.2002.460512.x
    1. Svenmarker S, Engström KG, Karlsson T, et al. . Influence of pericardial suction blood retransfusion on memory function and release of protein S100B. Perfusion 2004;19:337–43. 10.1191/0267659104pf768oa
    1. Goldman S, Sutter F, Ferdinand F, et al. . Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum 2004;7:E376–E381. 10.1532/HSF98.20041062
    1. McMurtrey RJ, Zuo Z. Isoflurane preconditioning and postconditioning in rat hippocampal neurons. Brain Res 2010;1358:184–90. 10.1016/j.brainres.2010.08.015
    1. Lee JJ, Li L, Jung HH, et al. . Postconditioning with isoflurane reduced ischemia-induced brain injury in rats. Anesthesiology 2008;108:1055–62. 10.1097/ALN.0b013e3181730257
    1. Julier K, da Silva R, Garcia C, et al. . Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study. Anesthesiology 2003;98:1315–27. 10.1097/00000542-200306000-00004
    1. Kim M, Kim M, Kim N, et al. . Isoflurane mediates protection from renal ischemia-reperfusion injury via sphingosine kinase and sphingosine-1-phosphate-dependent pathways. Am J Physiol Renal Physiol 2007;293:F1827–F1835. 10.1152/ajprenal.00290.2007
    1. Lee HT, Kim M, Kim J, et al. . TGF-beta1 release by volatile anesthetics mediates protection against renal proximal tubule cell necrosis. Am J Nephrol 2007;27:416–24. 10.1159/000105124
    1. Beck-Schimmer B, Breitenstein S, Urech S, et al. . A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg 2008;248:909–18. 10.1097/SLA.0b013e31818f3dda
    1. Li H, Yin J, Li L, et al. . Isoflurane postconditioning reduces ischemia-induced nuclear factor-κB activation and interleukin 1β production to provide neuroprotection in rats and mice. Neurobiol Dis 2013;54 216–24. 10.1016/j.nbd.2012.12.014
    1. Zuo Z. A novel mechanism for sevoflurane preconditioning-induced neuroprotection. Anesthesiology 2012;117:942–4. 10.1097/ALN.0b013e31826cb48c
    1. Uhlig C, Bluth T, Schwarz K, et al. . Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2016;124:1230–45. 10.1097/ALN.0000000000001120

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