Original articleDesflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials
Section snippets
Methods
Pertinent studies were independently searched in BioMedCentral and PubMed (updated January 30, 2006) by 4 trained investigators (G.L., O.F., E.B., and S.D.). The full PubMed search strategy was developed according to Biondi-Zoccai et al39 and is available in Appendix 1. Further hand or computerized searches involved the recent (2002-2006) conference proceedings from the International Anesthesia Research Society, American Heart Association, American College of Cardiology, American Society of
Results
Database searches, snowballing, and contacts with experts yielded a total of 506 citations. Excluding 445 nonpertinent titles or abstracts, the authors retrieved 65 studies in complete form and assessed according to the selection criteria. A total of 43 studies were further excluded because of their nonexperimental design, including the use of historic controls, or because of duplicate publication. Specifically, 14 studies were excluded because of duplicate publication either explicitly
Discussion
A meta-analysis of pooled data from several small studies was performed and showed that desflurane and sevoflurane significantly decreased the rate of MI and death in patients undergoing cardiac surgery. Although significantly underpowered, most studies included in this analysis showed positive trends, consistent with the overall positive results of the meta-analysis. This is the first time that the choice of an anesthetic regimen has been shown to have an impact on patient outcomes after
Acknowledgment
This study is part of a senior training project of the Center for Overview, Meta-analysis, and Evidence-based Medicine Training (COMET), based in Milan, Italy (http://www.comet.gs). The current authors thank the authors of the trials included in this review who answered our questions. Thanks also to Giardina Giuseppe, RN, Antonioni Giliola, RN, Mella Francesca, RN, Castelnuovo Lara, RN, Pandi Frederic, RN, Zarantonello Sabrina, RN, Costantini Marco, RN, Castello Adams, RN, and Carminati Nicola,
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Six authors acknowledge receiving drugs (A. Zangrillo by Baxter [desflurane]), reimbursement for conferences-simposia (G. Landoni, F. Guarracino, L. Tritapepe, S. De Hert, all by Abbott [sevoflurane]), or a research grant (G. Torri by Abbott) or honoraria for writing a CD on sevoflurane (F. Guarracino, L. Tritapepe, by Abbott). All 6 authors received modest support with the exception of G. Torri.