tipology:editorial

numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2(1): 5-6
PDF version

Preventing mortality in cardiac surgery with anesthetic drugs and techniques. There is need for a consensus conference

Authors: G. Landoni*, A. Zangrillo

Department of Anesthesia and Intensive Care, UniversitÓ Vita-Salute San Raffaele, Milan, Italy

Corresponding author: * Corresponding author:
Landoni Giovanni, MD
Department of Cardiothoracic Anesthesia and Intensive Care
UniversitÓ Vita-Salute San Raffaele,
60 - 20132 Milano, Italy
E-mail: landoni.giovanni@hsr.it

Anesthesiologists use a variety of drugs that have non-anesthetic, pharmacological properties that could reduce early and long term mortality in patients undergoing cardiac surgery.
The use of specific anesthetic drugs [1,2,3] and techniques [4], together with drugs managed mainly by cardiac anesthesiologists[5,6,7,8,9] have recently been associated with improved perioperative survival in cardiac surgery . [10] The numbers needed to treat are impressive (Table 1).

 

 

Table 1

Agents to reduce perioperative mortality in cardiac surgery with the number needed to treat (NNT) to prevent one death. All data are derived from meta-analysis of randomized controlled trials.

*For epidural analgesia the composite end point mortality and/or myocardial infarction is considered

 

Anesthesiologists should try and identify more drugs and techniques with similar extraordinary properties and, at the same time, study them prospectively with large multicentre randomized controlled trials. The Italian Association for Cardiothoracic Anesthesia (ITACTA) is conducting large, non-sponsored,randomized multicentre trials to clearly document the beneficial effects of volatile agents, levosimendan, fenoldopam and desmopressin in patients with or at high risk for severe myocardial dysfunction, acute renal failure and blood transfusion complications (see www.clinicaltrials.org for details).
We think it’s time to call for an international consensus conference to identify which agents are really beneficial for clinically relevant outcomes (all-cause mortality) in cardiac surgery and anesthesia. The aim of this consensus conference will be to identify any drug or technique that can reduce (or increase) short or long term mortality in patients undergoing cardiac surgery as suggested by at least one randomized controlled trial (RCT) or by a meta-analysis of RCTs or by a subgroup analysis of RCT/metaanalysis. Readers of “HSR Proceedings in Intensive Care and Cardiovascular Anesthesia” are invited to send email contributions (pdf papers on drugs or techniques that can affect mortality in cardiac anesthesia/surgery) and suggestions to landoni.giovanni@hsr.it .
Their contribution will be acknowledged and the suggested papers will be evaluated in the consensus conference. They’ll also be welcome to participate to the consensus conference that will be held in Milano in 2010. Non-randomized evidence and suggestions will be considered if time permits.

 

References

  1. Bignami E, Biondi-Zoccai G, Landoni G, et alii. Volatile anesthetics reduce mortality in cardiac surgery J Cardiothorac Vasc Anesth 2009; 23: 594-599.
  2. Landoni G, Biondi-Zoccai GG, Zangrillo A, et alii. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials J Cardiothorac 2007; 21: 502-511.
  3. Landoni G, Fochi O, Tritapepe L, et alii. Cardiac protection by volatile anesthetics. A review Minerva Anestesiol 2009; 75: 269-273.
  4. Bignami E, Landoni G, Biondi-Zoccai GG, et alii. Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials J Cardiothorac Vasc Anesth 2009; Epub ahead of print.
  5. Zangrillo A, Biondi-Zoccai GG, Mizzi A, et alii. Levosimendan reduces cardiac troponin release after cardiac surgery: a meta-analysis of randomized controlled studies J Cardiothorac Vasc Anesth 2009; 23: 474-478.
  6. Landoni G, Mizzi A, Biondi-Zoccai GG, et alii. Reducing mortality in cardiac surgery with levosimendan: a meta-analysis of randomized controlled trials J Cardiothorac Vasc Anesth 2010; 24: 51-57.
  7. Landoni G, Mizzi A, Biondi-Zoccai GG, et alii. Levosimendan reduces mortality in patients requiring inotropic support. A meta-analysis of randomised controlled studies Minerva Anestesiol 2010; In Pre:
  8. . Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis J Cardiothorac Vasc Anesth 2008; 22: 27-33.
  9. Landoni G, Biondi-Zoccai GG, Tumlin JA, et alii. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials Am J Kidney Dis 2007; 49: 56-68.
  10. Landoni G, Zambon M, Zangrillo A. Reducing perioperative myocardial infarction with anesthetic drugs and techniques Curr Drug Targets 2009; 10: 858-862.