*, Hospitais da Universidade de Coimbra, EPE (Coimbra), João Bonifácio, M.D., Sofia Marques, M.D., Tânia Teresa dos Santos Ralha, M.D.*. The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease. (B) Forest plot per treatment of in-hospital mortality. A place on a waterway with facilities for loading and unloading ships. We hypothesized that, compared to TIVA, the use of volatile anesthetics during general anesthesia is associated with reduced mortality and incidence of postoperative pulmonary and other complications in noncardiac and cardiac surgery patient populations. In cardiac surgery patients, compared to TIVA, volatile anesthetics were associated with lower incidence of other postoperative complications (OR = 0.75; 95% CI, 0.58 to 0.96; z = 2.26; P = 0.024; I2 = 38.6%; fig. Amateur Sports Team. Leva M.C., Raffetti A., Perassi A, MODELLING OF CAUSATION FACTORS FOR SHIP UNDER POWER AND MODEL OF THE OPERATOR, Human Factor Workshop, Genoa Italy, 6th of October 2005, edited by Cetena , 2005 Conference Paper, 2005 The current results might be valuable for estimation of effect sizes and sample size calculations when designing such studies. Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators; Appendix 1. 2. Aquario di Genova The Aquarium of Genoa Italy. *Events were given as event per patient and overall number of events per patient. Uhlig and Bluth contributed equally to this article. The locally responsible investigator also applied for and obtained approval from the ethics committee of each participating hospital. (A) Forest plot of postoperative pulmonary complications of noncardiac surgery patients. Sevoflurane-induced delayed neuroprotection involves mitoK(ATP) channel opening and PKC ε activation. 6:19 . ); Center for Evidence-Based Healthcare, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany (K.S., S.D., L.H., J.S. 7 of Supplemental Digital Content 2, http://links.lww.com/ALN/B271) compared to TIVA. The Peto odds ratio viewed as a new effect measure. Drs. What is your research question? Three trials (388 patients; two cardiac surgery) compared volatile anesthetics (sevoflurane n = 177, desflurane n = 58, isoflurane n = 153) among each other without a TIVA control group32–34  and were included in the network meta-analysis only. *, 10 Wojskowy Szpital Kliniczny z Polikliniką w Bydgoszczy (Bydgoszcz) Dominika Bożiłow, M.D., Robert Goch, M.D. Second, the presence of comorbidities that influence the risk of death, for example, cancer, may have acted as confounders. Moreover, the results of the exploratory analysis of the ARISCAT score’s prediction of single components of the composite outcome (Supplemental Digital Content 3, http://links.lww.com/ALN/B57) suggested that the most powerful predictors in the ARISCAT model would also be good predictors in a refitted predictive model for any component of the composite. Amateur Sports Team. Mortality in noncardiac surgery. The analysis also revealed a positive interaction between the score’s prediction of risk and WE geographic zone; put another way, the ARISCAT score performed best in this region, even better than in the Spanish cohort. Dec 2005; Emanuele Cordano. We also carried out a supplementary exploration of the performance of the ARISCAT model’s ability to predict single components of the composite and alternative composite outcomes in the PERISCOPE sample by calculating adjusted odds ratios for each predictor and c-statistics for the each individual PPC outcome and alternative composites. Andrés Manuel López Obrador (Spanish pronunciation: [anˌdɾes maˈnwel ˈlopes oβɾaˈðoɾ] (); born 13 November 1953), also known by his initials AMLO, is a Mexican politician serving as the current president of Mexico since 1 December 2018.. Born in Tepetitán, in the municipality of Macuspana, in the south-eastern state of Tabasco, López Obrador graduated from the National Autonomous University of … Postoperative pulmonary complications were recorded by the investigators throughout the postoperative hospital stay up to a maximum of 5 weeks. Sixty-five RCTs (6,716 patients) compared volatile anesthetics (n = 3,506 total, sevoflurane n = 1,895, desflurane n = 708, isoflurane n = 903) to TIVA (n = 3,210). Potential synergy of antioxidant N-acetylcysteine and insulin in restoring sevoflurane postconditioning cardioprotection in diabetes. Likelihood ratios (table 5) are the measures that best summarize the usefulness of a prognostic test. Fundacio Althaia (Manresa); Mauricio Roberto Argañaraz Quinteros, M.D., Carme Font Bosch, M.D., Jordi Torrellardona Llobera, M.D.*. Hospital de Denia (Denia), Francisca Llobell, M.D.,* Daniel Paz Martin, M.D. No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. Effects of anesthetic regimes on inflammatory responses in a rat model of acute lung injury. Insurance Broker. Three numerically comparable subsamples were defined, based on their geographic distance from the development population as follows: Spain, Western Europe (WE), and Eastern Europe (EE). TIVA = total IV anesthesia; VOL = volatile anesthetics; volatiles = volatile anesthetics. 3. Search for other works by this author on: Oxford Academic. sampd. Hospital Son Llatzer (Palma de Mallorca), Julio Belmonte Cuenca, M.D.,* Marcos José Bonet Binimelis, M.D., Ivaylo Grigorov, M.D., Josep Lluis Aguilar, M.D. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: An overview and tutorial. Perioperative and anaesthetic-related mortality in developed and developing countries: A systematic review and meta-analysis. Statistical analyses were performed using network meta-analysis method. *, Azienda USL n. 5 di Pisa Ospedale F. Lotti (Pontedera), Paolo Carnesecchi, M.D., Denise Lazzeroni, M.D., Irene Lorenzi, M.D.*. These results allow us to define the score as a tool with moderate to good clinical utility to estimate the risk of complications. The relationships between length of stay and in-hospital mortality and number of PPCs are shown in table 4. Insurance Broker. 402-948-4865 Gareth Pytlak. (C) Forest plot per treatment of postoperative pulmonary complications. This outcome was therefore considered as a binary categorical variable (yes/no) for the purposes of statistical analysis. A.S.D. Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: A double-blinded, placebo-controlled, multicenter study. Exclusion criteria were age under 18 yr, obstetric procedures or any intervention during pregnancy, procedures in which only local or peripheral nerve anesthesia would be used, procedures outside an operating theater, procedures related to a previous postoperative complication, transplantation, patients with preoperatively intubated trachea, and outpatient procedures (hospital stay of <24 h). The fact that, in cardiac surgery patients, lower incidences of pulmonary and other complications were not associated with reduced LOS in ICU or hospital might be due to standard operating procedures determining a minimal period of stay for this type of surgery. A port of entry. Mortality in cardiac surgery. Search for other works … Supplemental Digital Content is available for this article. 2. ); Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (M.G.d.A. 8), but such association was not observed in noncardiac surgical procedures (OR = 0.70; 95% CI, 0.46 to 1.05; z = 1.78; P = 0.075; I2 = 0.0%; fig. Medical Faculty of Istanbul, Istanbul University (Istanbul), Semra Kucukgoncu, M.D., Nuzhet Mert Sentürk, M.D.,* Zerrin Sungur Ulke, M.D. The Mantel–Haenszel test was used to analyze trends in mortality rates between those subgroups. Africa. The National Veterans Administration Surgical Quality Improvement Program. Africa; Antarctic; Arctic; Asia; Australia; Europe; North America; South America ; Home; Home Europe Bulgaria 5 Leva 1922. A.S.D. TIVA = total IV anesthesia; VOL = volatile anesthetics; volatiles = volatile anesthetics. Three predicted risk groups were then defined according to the cutoffs identified in the ARISCAT study1  by means of the minimum description length principle: <26 (low), ≥26 and <45 (intermediate), and ≥45 (high risk). Hospital Arnau de Vilanova (Lleida), Mercedes Matute, M.D.*. 6 and 7). (A) Forest plot of postoperative pulmonary complications of cardiac surgery patients. The Mann–Whitney U test was used to compare means and the chi-square test or Fisher exact test to compare percentages. Estratti dall'Acquario di Genova - Excerpts from the Aquarium of Genoa. Our study of the performance of the seven-factor ARISCAT score (table 1) in patient samples that were progressively distant from the development setting provides an intermediate level of evidence according to the definition of Justice et al.,19  supporting the use of this model for PPC risk prediction in a broad European surgical population in which the observed incidence of PPCs fell within the ranges reported for similar settings.4,9  The results in each external sample additionally illustrate the degree to which external validation has potential clinical significance, as it suggests that even a validated score may need further adjustments for populations with characteristics that diverge from those previously studied.23,27,28. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. Written informed consent to use the data was obtained from each enrolled patient in all centers. Significant risk in the EE region is evident even after adjustment, but the odds ratio implies that there are additional unknown risk factors in this area. Among patients with PPCs, 263 (65%) had more than one complication and 141 (35%) had three or more. All included trials reported either in-hospital, 30-day, 180-day, or 1-yr mortality (fig. β-Blockade during and after myocardial infarction: An overview of the randomized trials. In 2005 the live double-album Anfiteatro Live, recorded in the amphitheatre in Cagliari, was released; it also included a DVD of the concert. For measures of discrimination and diagnostic accuracy, the ARISCAT clinical score was used, whereas for calibration the linear predictor equation was used because it gives a more accurate mathematical assessment of each patient’s outcome risk. The calibration slope b was significantly lower than the ideal (b = 1) in all PERISCOPE subsamples studied (table 5). Furthermore, the antiinflammatory effects of volatile anesthetics40,41  are not limited to the lungs or heart, but affect also other organs, including brain,42,43  kidneys,44,45  and liver.46–49  In addition, a more recent meta-analysis demonstrated a reduction of acute kidney injury and renal failure after cardiac surgery under general anesthesia with volatile anesthetics compared to TIVA.50  Such effects might be related to favorable transcriptional changes in pro- and antiprotective mechanisms, as demonstrated for sevoflurane.51. *, Hospital Universitario Virgen del Rocio (Sevilla), Elvira Castellano Garijo, M.D.*. Whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery remains unknown. In noncardiac surgery patients, volatile anesthetics seem not to be associated with a relevant outcome benefit compared to TIVA. (Miskolc), Kristina Bráz, M.D., Csilla Ruszkai, M.D.*. The adjustment of the ARISCAT score for interaction with geographic area is also shown (see table 1, Supplemental Digital Content 3, http://links.lww.com/ALN/B57). Derivation and diagnostic accuracy of the surgical lung injury prediction model. Compared to TIVA, none of the single volatile anesthetics reduced pulmonary complications (figs. Concerning limitations, we are aware of the low representativeness of the samples with respect to the geographic areas in which they were obtained. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing volatile anesthetics with total IV anesthesia (TIVA) regarding patient outcome. 1 talking about this. Copyright © 2014, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Values are presented as odds ratio (OR) and 95% CI. This study also received support provided by Grant 041610-2003 from Fundació La Marató de Televisió de Catalunya, Barcelona, Spain. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery. Hospital Universitario de Móstoles (Madrid), Raquel Fernández Rocío Ayala Soto, M.D.,* Borja Quintana, M.D. Hospital Fernando Fonseca (Lisbon), Cristina Carmona, M.D.*. 5:02. Federico Marchetti je star 38 let (7. For example, ARDS and atelectasis were counted in the same way. Circle size represents the number of patients, and bar size represents the number of trials. Forty-five RCTs enrolled a total of 4,890 cardiac surgery patients of whom 2,587 received volatile anesthetics (sevoflurane n = 1,077, desflurane n = 673, isoflurane n = 837) and 2,303 received TIVA. Respiratory failure was the most frequent complication (241 patients, 4.7%), followed by pleural effusion (159, 3.1%), atelectasis (122, 2.4%), pulmonary infection (120, 2.4%), bronchospasm (42, 0.8%), pneumothorax (29, 0.6%), and aspiration pneumonitis (12, 0.2%). Accepted for publication January 18, 2016. Resident MD Fellowship in Plastic, Reconstructive, Aesthetic surgeon and Micro-surgeon Stradins University-Gailezers Hospital-Riga-Latvia gen 2007 - mag 2007 5 mesi. These findings are in agreement with a previous meta-analysis in the field.18  This may result from the observation of reduced postoperative complications with volatile anesthetics compared to TIVA, which are likely related to cardioprotective properties of those agents. The articles for this review were selected by examining titles, abstracts, and the full text if a potentially relevant trial was identified. Two of these studies, with pneumonia10  and respiratory failure11  as outcomes, were performed in a population of American veterans; as 90% of the patients were men, the generalizability of the findings may be limited. Statistical significance was accepted α less than 0.05. In-hospital mortality in the group of patients with at least one PPC (8.3%) was significantly higher than in patients with no PPC (0.2%; P < 0.0001). Anesthesiology 2016; 124:1230–1245 doi: https://doi.org/10.1097/ALN.0000000000001120. The main results of this systematic review and meta-analysis were that general anesthesia with volatile anesthetics, as compared to TIVA, was associated with reduced mortality and lower risk of pulmonary and other complications in cardiac, but not in noncardiac, surgery. Genoa Club Bucanieri Rossoblu. To adjust the ARISCAT score for the influence of European regional influence, we performed a logistic regression with PPC occurrence as the dependent variable and the ARISCAT score (three levels of risk) and geographic area (Spain, WE, and EE) as independent variables. That ability to distinguish risk makes the score a validated starting point for controlled trials and audits of risk-reduction strategies. For each outcome, we independently and in duplicate rated the overall quality of evidence (confidence in effect estimates) using the Grading of Recommendations, Assessment, Development and Evaluations approach in which trials begin as high-quality evidence, but may be rated down by one or more of five categories of limitations: risk of bias, inconsistency, indirectness, imprecision, and reporting bias.24  Finally, the overall risk of bias for an individual trial was categorized as “low” (if the risk of bias was low in all domains), “unclear” (if the risk of bias was unclear in at least one domain, with no high risk of bias domains), or “high” (if the risk of bias was high in one or more domains). The presented review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.19  A complete PRISMA checklist is presented in table 1 of Supplemental Digital Content 1, http://links.lww.com/ALN/B270. Postoperative complications in cardiac surgery. By continuing to use our website, you are agreeing to, The Postoperative and Opioid-free Anesthesia (POFA) Randomized Clinical Trial, https://doi.org/10.1097/ALN.0000000000001120, Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis: Erratum, Original Articles Corrected According to 2016 Errata, Part I, Balanced Opioid-free Anesthesia with Dexmedetomidine, Calculating Ideal Body Weight: Keep It Simple, Opioid-free Anesthesia: Time to Regain Our Balance, Safety of Perioperative Glucocorticoids in Elective Noncardiac Surgery: A Systematic Review and Meta-analysis, Ketamine Pharmacokinetics: A Systematic Review of the Literature, Meta-analysis, and Population Analysis, Susceptibility to Fraud in Systematic Reviews: Lessons from the Reuben Case, Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis, N -terminal pro-B-type Natriuretic Peptides’ Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds, © Copyright 2021 American Society of Anesthesiologists. Our confirmation that the length of hospital stay and in-hospital mortality increase as PPCs rise in number in the external samples (table 4) underlines the importance of a patient’s development of any single respiratory event included in the composite. Statistical significance was accepted α less than 0.05. Statistical analyses were performed using the Peto OR method. Paolo Bartolini . *Events are given as event per patient and overall number of events per patient. Sevoflurane binds and allosterically blocks integrin lymphocyte function-associated antigen-1. Myocardial injury after noncardiac surgery: A large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. 0106048880. 17:23. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). DES = desflurane; ISO = isoflurane; SEV = sevoflurane; TIVA = total IV anesthesia. References refer to table 5 of the Supplemental Digital Content 1, http://links.lww.com/ALN/B270. MISEK Kft. Demographic and Clinical Characteristics: Differences between the ARISCAT Development Sample and the PERISCOPE Cohort and Subsamples, Postoperative Length of Hospital Stay and Mortality According to Number of PPCs. Fourth, we cannot rule out that publication bias did impair our analysis, since negative results are more likely not to be published. Accurate predictions discriminate between patients with the outcome and those without. Six others used retrospective data sets to develop a score to predict single PPC outcomes: unplanned reintubation,12–14  postoperative pulmonary failure,15  and adult respiratory distress syndrome.16,17  Finally, two1,3  were prospective studies in patients undergoing a wide range of surgeries and only one was internally validated.1  To our knowledge, none of these studies have been replicated in other settings to externally validate the scores in new prospectively collected samples of patients, and for this reason, none can be confidently generalized.18,19  The lack of validated models affects the clinician’s ability to predict and plan strategies to prevent PPCs in high-risk groups. ); Department of Anesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (J.B.); Department of Anesthesiology and Critical Care, Université Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (O.L. Cralmen. Emergency Institute of Cardiovascular Diseases Prof. Dr. C. C. Iliescu (Bucharest), Daniela Filipescu, M.D.*.