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Journal of Clinical Anesthesia Sep 2013To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA). (Comparative Study)
Comparative Study Meta-Analysis
The effect of sevoflurane versus desflurane on the incidence of upper respiratory morbidity in patients undergoing general anesthesia with a Laryngeal Mask Airway: a meta-analysis of randomized controlled trials.
STUDY OBJECTIVE
To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA).
DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING
Operating room of an academic medical center.
MEASUREMENTS
A systematic review of RCTs of patients receiving general anesthesia with a LMA was performed. Sevoflurane and desflurane were used for maintenance of anesthesia in the RCTs. A wide search was performed to identify RCTs comparing desflurane with sevoflurane on the incidence of upper respiratory adverse events in patients undergoing surgery with a LMA. The primary outcomes were incidence of cough and laryngospasm. A random-effects model was used to perform quantitative analysis.
MAIN RESULTS
Data originating from 7 studies comprising 657 subjects were analyzed. The confidence interval (CI) was large relative to a clinically significant difference in the incidence of overall cough and laryngospasm in patients receiving desflurane versus sevoflurane (odds ratio [OR; 95% CI] of 1.44 [0.49 - 4.1] and 3.06 [0.43 - 21.62]), respectively. The incidence of cough at emergence was greater in subjects receiving desflurane compared with sevoflurane (OR [95% CI] of 2.43 [1.2 - 4.7], number needed to harm [NNH] = 9.0); however, the analysis was limited by the presence of an asymmetric funnel plot suggesting the possibility of publication bias.
CONCLUSIONS
There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.
Topics: Anesthesia, General; Anesthetics, Inhalation; Cough; Desflurane; Humans; Incidence; Isoflurane; Laryngeal Masks; Laryngismus; Methyl Ethers; Randomized Controlled Trials as Topic; Respiration Disorders; Sevoflurane
PubMed: 23965188
DOI: 10.1016/j.jclinane.2013.03.012 -
Canadian Journal of Anaesthesia =... Sep 2006Coronary artery bypass graft surgery (CABG) is associated with cardiac complications, including ischemia, acute myocardial infarction (AMI), and death. Volatile... (Meta-Analysis)
Meta-Analysis
PURPOSE
Coronary artery bypass graft surgery (CABG) is associated with cardiac complications, including ischemia, acute myocardial infarction (AMI), and death. Volatile anesthetics have been shown to have a preconditioning-like effect. This systematic review assesses the effects of volatile anesthetics on cardiac ischemic complications and morbidity after CABG.
METHODS
Data were obtained, without language restriction, from searches of MEDLINE, Science Citation Index, PubMed, and reference lists. We included only prospective randomized controlled trials evaluating volatile anesthetics during CABG. Two reviewers independently abstracted data on myocardial ischemia, acute myocardial infarction (AMI), and death. Treatment effects were calculated as odds ratio (OR) with 95% confidence intervals (CI) for binary data, and weighted mean difference (WMD) with 95% CI for continuous data.
PRINCIPAL FINDINGS
Thirty-two studies (2,841 patients) were included. In comparison with iv anesthesia, volatile anesthetics were associated with reduced all-cause mortality (OR, 0.65; 95% CI, 0.36-1.18; P = 0.16). Enflurane was associated with increased AMI (OR, 1.34; 95% CI, 0.68-2.64; P = 0.40), whereas sevoflurane and desflurane reduced cardiac troponin I (cTnI) at six hours, 12 hr, 24 hr [WMD, -1.45; 95% CI (-1.73, -1.16); P < 0.00001], and 48 hr after operation.
CONCLUSION
This meta-analysis demonstrates sevoflurane and desflurane reduce the postoperative rise in cTnI. Sevoflurane-mediated reduction in cardiac troponin was associated with improved long-term outcomes in one study. This meta-analysis was not able to show that these positive effects on troponin were translated into improved clinical outcomes. Well-designed large randomized control trials are needed to further elucidate the differential cardio-protective effects of volatile anesthetics.
Topics: Anesthetics, Inhalation; Coronary Artery Bypass; Creatine Kinase, MB Form; Desflurane; Electrocardiography; Heart; Humans; Isoflurane; Methyl Ethers; Myocardial Ischemia; Sevoflurane; Troponin I
PubMed: 16960269
DOI: 10.1007/BF03022834