Objective: The aim of this meta-analysis was to investigate the cardioprotective properties of isoflurane versus any comparator in terms of the rate of myocardial infarction and all-cause mortality. Design: Pertinent studies were searched independently in Biomed, Central, PubMed, Embase, and the Cochrane Central Register of clinical trials. The primary endpoint was mortality at the longest follow-up available. Setting: A hospital. Participants: Randomized controlled trials. Intervention: A meta-analysis of 37 trials. Measurements and Main Results: The 37 included trials randomized 3,539 patients in cardiac (16 studies) and in noncardiac surgery (21 studies) with noninhalation comparators in 55% of trials. The overall analysis showed no difference in mortality between the isoflurane and control groups (16/1,602 [1.0%] v 23/1,937 [1.2%], odds ratios (OR) = 0.76 [0.39-1.47], p = 0.4 with 37 studies included) and no difference in the rate of myocardial infarction (3/1,312 [0.2%] v 1/1,532 [0.07%], OR = 2.03 [0.27-15.49], p = 0.5 with 30 studies included). Mortality was reduced in the isoflurane group when only studies with a low risk of bias were included in the analyses (0/540 [0%] v 5/703 [0.7%] in the control arm, OR = 0.13 [0.02-0.76], p = 0.02) with 4 cardiac and 6 noncardiac trials included and 5 noninhalation and 5 inhalation agents as the comparator. A trend was noted when a subanalysis was performed with propofol as a comparator (1/544[0.2%] v6/546 [1.1%], p = 0.05, with 16 studies included). Conclusions: lsoflurane reduced mortality in high-quality studies and showed a trend toward a reduction in mortality when it was compared with propofol. No differences in the rates of overall mortality and myocardial infarction were noted. (C) 2012 Elsevier Inc. All rights reserved.
The Effect of Isoflurane on Survival and Myocardial Infarction: A Meta-analysis of Randomized Controlled Studies / Elena, Bignami; Teresa, Greco; Luigi, Barile; Simona, Silvetti; Davide, Nicolotti; Oliviero, Fochi; Elio, Cama; Roberto, Costagliola; Giovanni, Landoni; BIONDI ZOCCAI, Giuseppe; Alberto, Zangrillo. - In: JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA. - ISSN 1053-0770. - STAMPA. - 27:1(2013), pp. 50-58. [10.1053/j.jvca.2012.06.007]