Effect of anesthesia methods on postoperative major adverse cardiac events and mortality after non-cardiac surgeries: a systematic review and meta-analysis.

Abstract

Postoperative major adverse cardiac events (MACEs) are the main cause of postoperative mortality, and controversies exist regarding the effects of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients after non-cardiac surgeries. A Meta-analysis about the effect of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries was conducted; Chinese databases (SinoMed, CNKI, Wanfang, and VIP) and English databases (Medline, EMBASE, PubMed, Springer, Ovid, the Cochrane Library, and Google scholar) were searched. Twenty-seven randomized controlled trials (RCTs) were included and 35340 patients were involved. The cardiac troponin I level (cTnI) on postoperative day 1 (MD: -0.39, 95% CI: -0.45--0.34, P<0.00001) and the incidence of myocardial ischaemia (OR: 0.43, 95% CI: 0.27-0.68, P=0.0004) within 3 postoperative days were significantly lower after sevoflurane anesthesia than propofol anesthesia. There were no differences in postoperative MACEs or in mortality within either 30 days or 1 year between sevoflurane and propofol anesthesia, or between N2O and non-N2O anesthesia. The cTnI on postoperative day 3 was significantly lower from epidural anesthesia combined with general anesthesia (GA) than from GA alone (MD: -0.61, 95% CI: -0.75--0.47, P<0.00001). However, there were no differences in myocardial infarction or mortality between epidural anesthesia combined with GA and GA alone, or between spinal anesthesia alone and GA alone. Sevoflurane anesthesia, or epidural combined with general anesthesia can provide short-term myocardial protective effect in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries.