Comparison Between the Protective Effect of Isoflurane and Propofol on Myocardium During Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

TL;DR

This study compares isoflurane and propofol for heart protection during heart surgery, finding no significant difference in their effectiveness.

Contribution

A systematic review and meta-analysis comparing the cardioprotective effects of isoflurane and propofol during CABG.

Findings

No significant difference in cardiac index or troponin I levels between isoflurane and propofol.

No significant effect on mortality, MI, or inotropic drug use.

Study quality was low, and results were inconclusive for most outcomes.

Abstract

Intravenous non-volatile anaesthetics like propofol are commonly used in
cardiac surgeries across several countries. Volatile anaesthetics like
isoflurane may help in protecting the myocardium and minimize
ischaemia-reperfusion injury. Hence, we did this review to compare the
cardioprotective effect of isoflurane and propofol among patients undergoing
coronary artery bypass grafting (CABG).

We conducted a search in the databases Medical Literature Analysis and
Retrieval System Online (or MEDLINE), Embase, PubMed Central®,
ScienceDirect, Google Scholar, and Cochrane Library from inception until
April 2021. We carried out a meta-analysis with random-effects model and
reported pooled risk ratio (RR) or standardized mean difference (SMD) with
95% confidence interval (CI) depending on the type of outcome.

We analysed 13 studies including 808 participants. Almost all were
low-quality studies. For cardiac index, the pooled SMD was 0.14 (95% CI:
-0.22 to 0.50); for cardiac troponin I, pooled SMD was 0.10 (95% CI: -0.28
to 0.48). For mortality, the RR was 3.00 (95% CI: 0.32 to 28.43); for MI,
pooled RR was 1.58 (95% CI: 0.59 to 4.20); and for inotropic drug use,
pooled RR was 1.04 (95% CI: 0.90 to 1.21). For length of intensive care unit
stay, the pooled SMD was 0.13 (95% CI: -0.29 to 0.55), while pooled SMD for
mechanical ventilation time was -0.02 (95% CI: -0.54 to 0.51).

Isoflurane did not have significant cardioprotective effect compared to
propofol following CABG. Hence, the anaesthetists need to check some viable
alternatives to manage these patients and reduce the rate of postoperative
complications.

Figures