Effect of anesthesia methods on postoperative major adverse cardiac events and mortality after non-cardiac surgeries: a systematic review and meta-analysis.

Introduction: Postoperative major adverse cardiac events (MACEs) are the main cause of postoperative mortality, and controversies exist regarding the effects of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients after non-cardiac surgeries.

Evidence Acquisition: A Meta-analysis about the effect of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries was conducted; Chinese databases (SinoMed, CNKI, Wanfang, and VIP) and English databases (Medline, EMBASE, PubMed, Springer, Ovid, the Cochrane Library, and Google scholar) were searched.

Evidence Synthesis: Twenty-seven randomized controlled trials (RCTs) were included and 35340 patients were involved. The cardiac troponin I level (cTnI) on postoperative day 1 (MD: -0.39, 95% CI: -0.45--0.34, P<0.00001) and the incidence of myocardial ischaemia (OR: 0.43, 95% CI: 0.27-0.68, P=0.0004) within 3 postoperative days were significantly lower after sevoflurane anesthesia than propofol anesthesia. There were no differences in postoperative MACEs or in mortality within either 30 days or 1 year between sevoflurane and propofol anesthesia, or between N2O and non-N2O anesthesia. The cTnI on postoperative day 3 was significantly lower from epidural anesthesia combined with general anesthesia (GA) than from GA alone (MD: -0.61, 95% CI: -0.75--0.47, P<0.00001). However, there were no differences in myocardial infarction or mortality between epidural anesthesia combined with GA and GA alone, or between spinal anesthesia alone and GA alone.

Conclusions: Sevoflurane anesthesia, or epidural combined with general anesthesia can provide short-term myocardial protective effect in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries.