• Regina El Dib, José E Guimarães Pereira, Arnav Agarwal, Huda Gomaa, Ana Patricia Ayala, and Andresa Graciutti Botan.
• Institute of Science and Technology, Unesp - Univ Estadual Paulista, São Paulo, São José dos Campos, Brazil; Department of Anaesthesiology, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Botucatu, Brazil; McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada. Electronic address: eldib@fmb.unesp.br.
• J Clin Anesth. 2017 Aug 1; 40: 127-138.

Study ObjectiveTo compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting.DesignA systematic review.SettingA hospital-affiliated university.MeasurementsThe following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10), MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the GRADE approach to rate overall certainty of the evidence.ResultsIn total we included 58 studies with a total of 6105 participants. The methodological quality was difficult to assess as it was poorly reported in 35 included studies (three or more domains were rated as unclear risk of bias). Two trials of sevoflurane showed a statistically significant reduction in death within 180 to 365days of surgery (on-pump) (RR 4.10, 95% CI 1.42 to 11.79; p=0.009; I2=not applicable; high quality of evidence). There was also a statistically significant difference favouring sevoflurane compared to propofol on both inotropic (RR 2.11, 95% CI 1.53 to 2.90; p<0.00001; I2=0%) and vasoconstrictor support needed (RR 1.51, 95% CI 1.04 to 2.22; p=0.03; I2=0%) after coronary artery bypass grafting on-pump. Two trials of sevoflurane (MD -0.22, 95% CI -0.41 to -0.03; p=0.02; I2=0%) and two further trials of desflurane (MD -0.33, 95% CI -0.45 to -0.20; p<0.00001; I2=82%) showed a statistically significant difference on cardiac index during and after coronary artery bypass grafting on-pump, respectively.ConclusionsThere is high quality evidence that sevoflurane reduces death within 180 to 365days of surgery and, inotropic and vasoconstrictor support compared to propofol for patients undergoing coronary artery bypass grafting. There is also some evidence showing that the cardiac index is minimally influenced by administration of sevoflurane and desflurane compared to propofol.Copyright © 2017 Elsevier Inc. All rights reserved.

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