The Anesthesia in Abdominal Aortic Surgery (ABSENT) Study

Abstract Background: On the basis of data indicating that volatile anesthetics induce cardioprotection in cardiac surgery, current guidelines recommend volatile anesthetics for maintenance of general anesthesia during noncardiac surgery in hemodynamic stable patients at risk for perioperative myocardial ischemia. The aim of the current study was to compare increased troponin T (TnT) values in patients receiving sevoflurane-based anesthesia or total intravenous anesthesia in elective abdominal aortic surgery. Methods: A prospective, randomized, open, parallel-group trial comparing sevoflurane-based anesthesia (group S) and total intravenous anesthesia (group T) with regard to cardioprotection in 193 patients scheduled for elective abdominal aortic surgery. Increased TnT level on the first postoperative day was the primary endpoint. Secondary endpoints were postoperative complications, nonfatal coronary events and mortality. Results: On the first postoperative day increased TnT values (>13 ng/l) were found in 43 (44%) patients in group S versus 41 (43%) in group T (P = 0.999), with no significant differences in TnT levels between the groups at any time point. Although underpowered, the authors found no differences in postoperative complications, nonfatal coronary events or mortality between the groups. Conclusions: In elective abdominal aortic surgery sevoflurane-based anesthesia did not reduce myocardial injury, evaluated by TnT release, compared with total intravenous anesthesia. These data indicate that potential cardioprotective effects of volatile anesthetics found in cardiac surgery are less obvious in major vascular surgery.

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Faculty Opinions recommendation of Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735349992.793560082 ◽

2019 ◽

Author(s):

Alain Vuylsteke ◽

Lucy Mwaura

Keyword(s):

Cardiac Surgery ◽

Volatile Anesthetics ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia

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Depth of anesthesia by Narcotrend® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

Perfusion ◽

10.1177/0267659119895447 ◽

2020 ◽

Vol 35 (5) ◽

pp. 427-435 ◽

Cited By ~ 1

Author(s):

Konstanze Plaschke ◽

Anne Weiskircher ◽

Laura Benner ◽

Bertold Klein ◽

Tsvetomir Loukanov ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Total Intravenous Anesthesia ◽

Depth Of Anesthesia ◽

Intravenous Anesthesia ◽

Ventilation Time ◽

Anesthesia Group ◽

Balanced Anesthesia ◽

Postoperative Ventilation

Background: Depth of anesthesia may be insufficient in pediatric cardiac anesthesia if a total intravenous anesthetic regimen with opioids and midazolam is used during cardiopulmonary bypass. The advantages of sevoflurane-based balanced anesthesia may be (1) a more graduated regulation of the depth of anesthesia during cardiopulmonary bypass and (2) a reduction in postoperative ventilation time for children in comparison with total intravenous anesthesia. Aim: To evaluate a possibly positive effect of sevoflurane-based balanced anesthesia in children undergoing cardiac surgery we analyzed whether this anesthetic regimen had a significant effect related to (1) depth of anesthesia, (2) the need for opioids during cardiopulmonary bypass as well as on postoperative characteristics such as (3) time of postoperative ventilation, and (4) duration of stay in the intensive care unit in comparison with total intravenous anesthesia. Methods: In a retrospective analysis, data from heart-lung machine protocols from 2013 to 2016 were compared according to anesthetic regimen (sevoflurane-balanced anesthesia, n = 70 vs. total intravenous anesthesia, n = 65). Children (age: 8 weeks to 14 years) undergoing cardiac surgery with cardiopulmonary bypass were included. As a primary outcome measure, we compared Narcotrend® system–extracted data to detect insufficient phases of anesthetic depth during extracorporeal circulation under moderate hypothermia. Postoperatively, we measured the postoperative ventilation time and the number of days in the intensive care unit. Furthermore, we analyzed patients’ specific characteristics such as opioid consumption during cardiopulmonary bypass. Regression analysis relating primary objectives was done using the following variables: anesthetic regimen, age, severity of illness/surgery, and cumulative dosage of opiates during cardiopulmonary bypass. Results: No significant differences were observed in descriptive patient characteristics (age, body weight, height, and body temperature) between the two groups. Further, no significant differences were found in depth of anesthesia by analyzing phases of superficial B1-C2-electroencephalography Narcotrend® data. No marked difference between the groups was observed for the duration of postoperative intensive care unit stay. However, the postoperative ventilation time (median (95% CI, hours)) was significantly lower in the sevoflurane-based balanced anesthesia group (6.0 (2.0-15.0)) than in the total intravenous anesthesia group (13.5 (7.0-25)). A higher dosage of opioids and midazolam was required in the total intravenous anesthesia group to maintain adequate anesthesia during cardiopulmonary bypass. Regression analysis showed an additional, significant impact of the following factors: severity of illness and severity grade of cardiac surgery (according to Aristotle) on the primary endpoint. Conclusion: In children undergoing cardiac surgery in our department, the use of sevoflurane-balanced anesthesia during cardiopulmonary bypass showed no superiority of inhalational agents over total intravenous anesthesia with opioids and benzodiazepines preventing phases of superficial anesthesia, but a marked advantage for the postoperative ventilation time compared with total intravenous anesthesia.

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Faculty Opinions recommendation of Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735349992.793558924 ◽

2019 ◽

Author(s):

Martijn Boon

Keyword(s):

Cardiac Surgery ◽

Volatile Anesthetics ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia

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Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

New England Journal of Medicine ◽

10.1056/nejmoa1816476 ◽

2019 ◽

Vol 380 (13) ◽

pp. 1214-1225 ◽

Cited By ~ 61

Author(s):

Giovanni Landoni ◽

Vladimir V. Lomivorotov ◽

Caetano Nigro Neto ◽

Fabrizio Monaco ◽

Vadim V. Pasyuga ◽

...

Keyword(s):

Cardiac Surgery ◽

Volatile Anesthetics ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia

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Combined Epidural and General Anaesthesia versus General Anaesthesia for Abdominal Aortic Surgery: A Prospective Randomised Trial

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100607 ◽

1993 ◽

Vol 21 (6) ◽

pp. 790-794 ◽

Cited By ~ 46

Author(s):

M. J. Davies ◽

B. S. Silbert ◽

P. J. Mooney ◽

R. H. Dysart ◽

A. C. Meads

Keyword(s):

Postoperative Complications ◽

General Anaesthesia ◽

Aortic Surgery ◽

Randomised Trial ◽

Postoperative Outcome ◽

Abdominal Aortic Surgery ◽

Morphine Infusion ◽

Abdominal Aortic ◽

Number Of Patients ◽

Significant Difference

Fifty patients undergoing elective abdominal aortic surgery were randomised to receive either combined epidural and general anaesthesia and postoperative epidural analgesia (CEGA) or general anaesthesia and postoperative intravenous morphine infusion (GA). Prospective data was collected in order to compare the two groups. This included intraoperative cardiovascular changes and postoperative complications. The use of intraoperative vasopressors was significantly higher in the CEGA group (P <0.01) but the use of intravenous glyceryl trinitrate was significantly lower (P <0.01). There was no significant difference between groups in regard to blood loss, volume replacement or in the number of patients requiring postoperative ventilation. Two patients in the CEGA group died postoperatively compared to one in the GA group (not significant). There was no significant difference between groups in the total number or type of postoperative complications. Combining epidural anaesthesia with general anaesthesia altered intraoperative cardiovascular management but did not affect postoperative outcome.

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