Cardiac Surgery: No Difference in Outcomes Between Inhaled and IV Anesthesia

MedicalResearch.com Interview with:

Dr. Giovanni LandoniIntensive Care and Anesthesia Unit Associate professorUniversità Vita-Salute San Raffaele

Dr. Landoni

Dr. Giovanni Landoni
Intensive Care and Anesthesia Unit
Associate professor
Università Vita-Salute San Raffaele 

MedicalResearch.com: What is the background for this study?  

Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data.

MedicalResearch.com: What are the main findings? 

Response: We studied 5,400 patients undergoing cardiac surgery under inhalation anesthesia or intravenous anesthesia and found that both anesthesia techniques are safe, with no differences in perioperative outcomes and in one year mortality. 

MedicalResearch.com: What should readers take away from your report? 

  1. Large academic, collaborative, no profit trials are feasible
  2. Anesthesia techniques are safe and can be routinely applied to patients around the world 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: It is important that promising findings of small or single center studies are confirmed by large, pragmatic, investigator driven multicenter randomized trials before entering into guidelines. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: Physicians around the world are now widely connected. It would be important to have less bureaucracy for academic no-profit pragmatic trials. This would allow to perform several of these trials within short time (and not few trials which take several years to be completed). This is in the interest of patients and national health systems, but nobody seem to be aware or to care about it. 

Citation:

Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

Giovanni Landoni, M.D., Vladimir V. Lomivorotov, M.D., Ph.D., Caetano Nigro Neto, M.D., Ph.D., Fabrizio Monaco, M.D., Vadim V. Pasyuga, M.D., Nikola Bradic, M.D., Rosalba Lembo, M.Sc., Gordana Gazivoda, M.D., Valery V. Likhvantsev, M.D., Ph.D., Chong Lei, M.D., Ph.D., Andrey Lozovskiy, M.D., Nora Di Tomasso, M.D.,  for the MYRIAD Study Group*
March 28, 2019
N Engl J Med 2019; 380:1214-1225
DOI: 10.1056/NEJMoa1816476

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