2013, Number 2
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Rev Cubana Cardiol Cir Cardiovasc 2013; 19 (2)
Neuraxial anesthetics techniques associated with general anesthesia in car-diac surgery. Systematic review and metaanalysis
Agüero MMO, Jiménez PRE
Language: Spanish
References: 34
Page: 79-86
PDF size: 462.16 Kb.
ABSTRACT
Introduction: The systematic review associated by meta-analysis offers potential information about the effects of therapeutics me-thods and constitutes the methodologies guidelines for the evaluation of them.
Objective: We performed this study to evaluate the benefits of neuraxial anesthetics techniques associated with general anesthesia, in the perioperative evolution of patients undergoing cardiac surgery.
Method: The randomized controlled trials published between January 2004 and February 2011 were included. The systematic review was made using recommended guidelines from the Cochrane collaborations management system. In the metaanalysis for dichotomous outcomes the odds ratios and relative risk were calculated and for continuous outcomes the means differences was evaluated. Also the heterogeneity between the studies was analyzed and the sensibility analysis was made.
Results: 24 trials, enrolling 2 388 patients were included. The association of neuraxial anesthetics techniques with general anesthesia reduces the risk of pulmonary complications, the opiods consumption, the time of tracheal extubation and the hospital stay. Referent to intensive care unit stay and cardiac morbidity, the differences were lesser. The risk of spinal hematoma remains uncertain.
Conclusions: The association of neuraxial anesthetics techniques with general anesthesia in patients undergoing cardiac surgery improved the perioperative evolution.
REFERENCES
Laporte J R. Meta-análisis de ensayos clínicos. En: Princi-pios básicos de la investigación clínica. 2da ed. España; 2001. [En línea]. [Consulta: 19 septiembre del 2010]. URL disponible en: http://www.icf.uab.es/llibrete/cap6.htm.
Clarke M, Oxman AD, editors. Cochrane Reviewers Hand-book 4.1.6 (update March 2003). [En línea]. [Consulta: 19 enero del 2009]. URL Disponible en: http://www.cochrane.dk/cochrane/handbook.htm.
Bailar JC. The promise and problems of meta-analysis. N Engl J Med 1997; 33: 559-61.
Liu SS, Block BM, Wu Ch L. Effects of per operative central neuroaxial analgesia on outcome after coronary artery bypass surgery. Anesthesiology 2004; 101 (1): 153-61.
Zangrillo A, Bignami E, Giuseppe GL, Zoccai B, Covello RD, Monti G, et al. Spinal analgesia in cardiac surgery: A meta-analysis of randomized controlled trials. J Cardiovasc Anesth 2009; 23 (6):813-21.
Bignami E, Landoni G, Giuseppe GL , Zoccai B, Baroli F, Messina M, et al. Epidural analgesia improves outcome in cardiac surgery: A meta-analysis of randomized controlled tri-als. J Cardiovasc Anesth 2009; 20 (10):30.
Vesna S, Diederik DV, Arno PN, Martijn PP, Cor JR, Geert JH, et al. Meta-analysis of thoracic epidural anaesthesia ver-sus general anaesthesia for cardiac surgery. Anesthesiology 2011; 114(2): 271-82.
Ruppen W, Derry S, McQuay HJ, More RA. Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia–anaesthesia: systematic re-view and meta-analysis. Anesthesiology 2006; 6: 10.
Ronal A, Abdulaziz KA, George TD y Scout M. In patients undergoing cardiac surgery, Thoracic epidural analgesia combined with general anaesthesia results in faster recovery and fewer complications but does not affect length of hospital stay. Interac Cardiovasc thorac surg 2006; 5:207-16. [En línea]. [Consulta: 4 junio del 2007]. URL Disponible en: http://icvts.ctsnetjournals.org/mis/ters.dtl.
Richardson L, Dunning J, Hunter S. Is intratecal morphine of benefit to patients undergoing cardiac surgery? Interac Car-diovasc Thoracic Surg 2008. [En línea]. [Consulta: 3 abril del 2009]. URL Disponible en: www.icvts.org.
Agüero MO, Jiménez R, Cruz BR, Nodal P, Pérez M, García R. Analgesia perioperatoria en cirugía cardiovascular: Ante-cedentes. Nuevas alternativas. Rev Cub Anest Reanim 2009; 8(3). [En línea]. [Consulta: 23 enero del 2009]. URL disponi-ble en: http://bvs.sld.cu/revistas/scar/indice.htm.
Clarke M, Oxman AD, editors. Cochrane Reviewers Hand-book 4.1.6 (update March 2003). [En línea]. [Consulta: 19 enero del 2009]. URL Disponible en: http://www.cochrane.dk/cochrane/handbook.htm.
Moher D, Schulz KF, Altman DG. The CONSORT Statement: revised recommendations for improving the quality of report of parallel group randomized trials. Lancet 2001; 357: 1191-94.
Agüero MO, Jiménez PR, Villar IA, Nafeh M, Pedroso RJ. Anestesia neuroaxial combinada con anestesia general en la cirugía coronaria sin circulación extracorpórea. Resultados preliminares. Rev Cub Cardiol Cir Cardiovasc 2010; 16 (4): 431-42. [En línea]. [Consulta: 2 enero del 2010]. URL dispo-nible en: http://bvs.sld.cu/revistas/card/indice.htm.
Samaniego A, Mourelle P, Riva J, Piñeiro H. Analgesia intra-tecal con morfina–fentanil en cirugía cardíaca. Anest Analg Reanim 2005; 20(1):3-13.
Mehta Y, Kulkarni V, Juneja R, Sharma KK, Mishara Y, Rai-zada A,Trehan N. Spinal (subarachoid) morphine for off-pump coronary artery bypass surgery. Heart Surg Forum 2004; 7(3): E 205-10.
Yapici D, Ozer ZO, Atici S, Bilgin E, Doruk N, Cinel I, et al. Postoperative effect of low-dose intratecal morphine in coro-nary artery bypass surgery. J Card Surg 2008; 23: 140-45.
Gurkan T, Goren S, Sahin S, Gulsen K, Sayan E. Combina-tion of intrathecal Morphine and Remifentanil Infusion for fast-track Anesthesia in off pump Coronary artery bypass Surgery. J Cardiothorac Vasc Anesth 2005; 19 (6): 708-13.
Roediger L, Joris J, Sernasd M, Larbuisson R, Canivet JL, Lamy M. The use of pre-operative intratecal morphine for analgesia following coronary artery bypass surgery. Anesthe-sia 2006; 61: 838-44.
Lena P, Balarac N, Arnulf JJ, Bigeon JY, Tpaia M, Bonnet F. Fast-Track Coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine. J Cardiothorac Vasc Anesth 2005; 19 (1): 49-53.
Lena P, Balarac N, Lena D, De la Chapelle A, Arnulf JJ, Mihoubi A, Bonnet F. Fast-track anesthesia with remifentanil and spinal analgesia for cardiac surgery: The effect on pain control and quality of recovery. J Cardiothorac Vasc Anesth 2008; 22 (4): 536-42.
Arhurin RS, Lepilin MG, Bajalieva A, Torshin SV, Lepilin PM. Peculiarities of hemodynamic changes during high thoracic epidural anesthesia in beating heart surgery. Eur J Gen Med 2005; 2(4): 144-49.
Bakhtiary F, Therapidis P, Dzemali O, Koray AK, Ackermann H, Meininger D, et al. Impact of high thoracic epidural anes-thesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: A prospective randomized study. J Thorac Cardiovasc Surg 2007; 134: 460-4.
Barrington MJ, Kluger R, Watson R, Scott DA, Karen HJ. Epidural Anesthesia for coronary artery bypass surgery com-pared with General anesthesia Alone does not reduce bio-chemical markers of myocardial damage. Anesth Analg 2005; 100(4): 921-28.
Moraes L, Canavi V, Canavi S, Malbouissan LM, Carvalo CJ. Intrathecal morphine plus general anesthesia in cardiac sur-gery: Effect on pulmonary function, post operative analgesia and plasma morphine concentration. Clinics (Sao Paulo) 2009; 64(4): 279-85.
Kurtoglu M, Ates S, Bakkaloglu B, Besbas S, Duvan I, Akdas H, Aybek T, Karagoz H. Epidural anesthesia in patients un-dergoing minimally invasive direct coronary artery bypass surgery. Anadolu Kardiyol Derg 2009; 9:54-8.
Vesna S, Nierich AP, Moons KG, Diephuis JC, Ennema JJ, Brandon BB, Kalman CJ, Van DD. Thoracic epidural anesthe-sia for cardiac surgery: A randomized Trial. Anesthesiology 2011; 114(2):262-69.
Tenenbein PK, Derouwere R, Maguire D, Duke PC, Muir-head B, Enns J, et al. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anesth 2008; 55(6): 344-50.
Caputo M, Hazaim A, Chis RA, Katie P, Alan C, Christopher M, et al. Thoracic Anesthesia improves outcomes in patients undergoing off-pump coronary artery bypass surgery: A pros-pective, Randomized, Controlled Trial. Anesthesiology 2011; 114(2): 380-90.
Hansdottir V H, Philip JR, Olsen MF, Eduard C, Erick H, Sven-Erick R. Thoracic epidural versus intravenous patient-controlled analgesia after Cardiac Surgery: A randomized controlled trial on Length of Hospital Stay and Patient-perceived Quality of recovery. Anesthesiology 2006; 104(1): 142-51.
Caputo M, Alwair H, Roger CA, Ginty M, Monk C, Tomkins S, et al. Myocardial, Inflammatory, and Stress Responses in off-pump coronary artery bypass surgery with thoracic epidural anesthesia. Ann Thorac Surg 2009; 87: 1119-26.
Nygard E, Sorensen LH, Hviid LB, Perdersen FM, Raun J, Thomasesn L, et al. Effects of amiodarone and thoracic epi-dural analgesia on atriall fribillation after coronary artery by-pass grafting. J Cardiothorac Vasc Anesth 2004; 18 (6): 709-14.
Bracco D, Hemmerling TM. Thoracic epidural analgesia in cardiac surgery: impact on postoperative morbidity. Tech Reg Anesth Pain Manag 2008; 12: 32-40.
Raja SG, Dreyfus GD. Off-pump coronary artery bypass surgery: to do or not to do? Current Best avaible evidence. J Cardiothorac Vasc Anesth 2004; 18(4):486-505.