Abstract
We evaluated whether volatile anesthetics can improve the postoperative outcomes of non-cardiac surgery in patients with preoperative myocardial injury defined by the cardiac troponin elevation. From January 2010 to June 2018, 1254 adult patients with preoperative myocardial injury underwent non-cardiac surgery under general anesthesia and were enrolled in this study. Patients were stratified into following two groups according to anesthetic agents; 115 (9.2%) patients whose anesthesia was induced and maintained with continuous infusion of propofol and remifentanil (TIVA group) and 1139 (90.8%) patients whose anesthesia was maintainted with volatile anesthetics (VOLATILE group). The primary outcome was 30-day mortality. To diminish the remifentanil effect, a further analysis was conducted after excluding the patients who received only volatile anesthetics without remifentanil infusion. In a propensity-score matched analysis, 30-day mortality was higher in the TIVA group than the VOLATILE group (17.0% vs. 9.1%; hazard ratio [HR] 2.60; 95% confidence interval [CI], 1.14–5.93; p = 0.02). In addition, the TIVA group showed higher 30-day mortality than the VOLATILE group, even after eliminating the effect of remifentanil infusion (15.8% vs. 8.3%; HR 4.62; 95% CI, 1.82–11.74; p = 0.001). In our study, the use of volatile anesthetics showed the significant survival improvement after non-cardiac surgery in patients with preoperative myocardial injury, which appears to be irrelevant to the remifentanil use. Further studies are needed to confirm this beneficial effect of volatile anesthetics.Clinical trial number and registry URL: KCT0004349 (www.cris.nih.go.kr)
Highlights
Cardioprotective effect of volatile anesthetics has been proven in numerous studies [1,2,3,4]
The aim of our study was to evaluate whether volatile anesthetics can improve 30-day mortality following non-cardiac surgery in patients with preoperative myocardial injury defined by the cardiac troponin elevation
According to the anesthetics used during anesthetic maintenance, the enrolled patients were grouped as follows: the TIVA group (n = 115), defined as the patients whose anesthesia was induced and maintained with continuous infusion of propofol and remifentanil without using a volatile anesthetic agent and the VOLATILE group (n = 1139), defined as the patients whose anesthesia was maintained with volatile anesthetics regardless of induction agents
Summary
Cardioprotective effect of volatile anesthetics has been proven in numerous studies [1,2,3,4]. The use of volatile anesthetics has been recommended to reduce postoperative mortality in patients undergoing major non-cardiac and cardiac surgeries [5,6,7]. A leading cause of postoperative mortality in non-cardiac surgery is myocardial injury [9], which was defined as the evidence of elevated cardiac troponin values with at least one value above the 99th percentile upper reference limit [9,10]. As well as postoperative myocardial injury, preoperative cardiac troponin elevation has been reported to be strongly associated with postoperative mortality in patients undergoing non-cardiac surgery [11,12,13]. Since volatile anesthetics can reduce myocardial infarct size and cardiac biomarkers [1], the use of volatile anesthetics might be effective to improve clinical outcomes after non-cardiac surgery, especially in patients with preoperative elevation of cardiac troponin
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
