Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

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• 作者：Fabiano Timb&oacute ; Barbosa^a ; ^{fabianotimbo@yahoo.com.br" class="auth_mail" title="E-mail the corresponding author} ; Rafael Martins da Cunha^b ; Fernando Wagner da Silva Ramos^a ; Fernando Jos&eacute ; Camello de Lima^a ; Amanda Karine Barros Rodrigues^a ; Ailton Mota do Nascimento Galvã ; o^a ; C&eacute ; lio Fernando de Sousa-Rodrigues^a ; Paula Monique Barbosa Lima^a
• 关键词：General anesthesia ; Neuraxial anesthesia ; Mortality ; Meta-analysis ; Coronary artery bypass
• 刊名：Brazilian Journal of Anesthesiology (English Edition)
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：66
• 期：2
• 页码：183-193
• 全文大小：920 K

文摘

Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction.

c_2">Methods

Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables.

c_3">Results

17 original articles analyzed. Meta-analysis of mortality (RD = −0.01, 95% CI = −0.03 to 0.01), CVA (RR = 0.79, 95% CI = 0.32–1.95), MI (RR = 0.96, 95% CI = 0.52–1.79) and LHS (MD = −1.94, 95% CI = −3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50–0.93). ICUS was lower in NA (MD = −2.09, 95% CI = −2.92 to −1.26).

c_4">Conclusion

There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.