Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

Barbosa, Fabiano Timbó; Rodrigues, Célio Fernando de Sousa; Castro, Aldemar Araújo; Cunha, Rafael Martins da; Barbosa, Tatiana Roa Bezerra Wanderley

doi:10.1016/j.bjane.2013.09.015

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Revista Brasileira de Anestesiologia

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REVIEW ARTICLE • Rev. Bras. Anestesiol. 66 (03) • May-Jun 2016 • https://doi.org/10.1016/j.bjane.2013.09.015 copy

Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?^☆ ☆ Study conducted at Universidade Federal de Alagoas, Maceió, AL, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients.

OBJECTIVE:

To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews.

CONTENT:

The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed.

CONCLUSIONS:

The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.

Keywords:
General anesthesia; Subarachnoid anesthesia; Thoracic epidural anesthesia; Systematic review; Mortality; Evidence

Database	Terms used
Pubmed	systematic[sb]
	and
	thoracic surgery [Mesh Terms] or (thoracic [all fields] and surgery [all fields]) or thoracic surgery [all fields] or (cardiac [all fields]and surgery [all fields]) or cardiac surgery [all fields] or cardiac surgical procedures [Mesh Terms] or (cardiac [all fields] and surgical [all fields] and procedures [all fields]) or cardiac surgical procedures [all fields] or (cardiac [all fields] and surgery [all fields])
	and
	general anaesthesia [all fields] or anesthesia, general [Mesh Terms] or (anesthesia [all fields] and general [all fields]) or general anesthesia [all fields] or (general [all fields] and anesthesia [all fields])

Topic for analysis	Liu et al.¹³	Zangrillo et al.¹⁴	Svircevic et al.¹⁵	Gu et al.¹⁶
1. Reported search methods	No	Yes	Yes	No
2. Comprehensive search	Undetermined	Yes	Yes	Undetermined
3. Inclusion criteria reported	Yes	Yes	Yes	Yes
4. Avoided selection bias	Undetermined	Yes	Yes	Undetermined
5. Validity criteria reported	Undetermined	Yes	Undetermined	Undetermined
6. Adequately assessed validity	Undetermined	Yes	Undetermined	Yes
7. Reported combined methods	Yes	Yes	Yes	Yes
8. Combining results properly	Yes	Yes	Yes	Yes
9. Conclusions supported by data	Yes	Yes	Yes	Yes

Study	Participants	Intervention	Comparison	Variables	n (N)
Liu et al.¹³	Adults, coronary insufficiency,CPB	GA + EA, GA + SA	GA	Mortality, heart attack, arrhythmias, pulmonary complications	1846 (32)
Zangrillo et al.¹⁴	Adults, cardiac surgery with or without CPB, myocardial ischemia, valve replacement	GA + SA	GA	Mortality, heart attack, hospital stay, length of stay in ICU, arrhythmias, complications	1106 (25)
Svircevic et al.¹⁵	Over 18 years, cardiac surgery	GA + EA	GA	Mortality, heart attack, CVA, supraventricular tachycardia, respiratory complications	2731 (28)
Gu et al.¹⁶	Over 18 years, coronary insufficiency CPB CPB	GA + EA	GA	Postoperative atrial fibrillation	540 (5)

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:fabianotimbo@yahoo.com.br (F.T. Barbosa).

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Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?☆ ☆ Study conducted at Universidade Federal de Alagoas, Maceió, AL, Brazil.

ABSTRACT

BACKGROUND AND OBJECTIVES:

OBJECTIVE:

CONTENT:

CONCLUSIONS:

Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?^☆ ☆ Study conducted at Universidade Federal de Alagoas, Maceió, AL, Brazil.