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Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials.

Zhang S, Wu X, Guo H, Ma L - Eur. J. Med. Res. (2015)

Bottom Line: Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05).TEA was also associated with significant reduction of stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P < 0.05) and hospital (MD, -1.51; 95% CI: -3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, -2.06; 95% CI:-2.68, -1.45, P < 0.05).TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of anesthesiology, General Hospital of Beijing military region PLA, Beijing, 100010, China. bzmzk@sohu.com.

ABSTRACT
To assess the efficacy of thoracic epidural anesthesia (TEA) with or without general anesthesia (GA) versus GA in patients who underwent cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of Science were searched with the limit of randomized controlled trials (RCTs) relevant to 'thoracic epidural anesthesia' and 'cardiac surgery'. Studies were identified and data were extracted by two reviewers independently. The quality of included studies was also assessed according to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory functions, and treatment-associated complications were pooled and analyzed. The comprehensive search yielded 2,230 citations, and 25 of them enrolling 3,062 participants were included according to the inclusion criteria. Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05). With regard to treatment-related complications, the pooled results for respiratory complications (risk ratio (RR), 0.69; 95% CI: 0.51, 0.91, P < 0.05), supraventricular arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P < 0.05), and pain (mean difference (MD), -1.27; 95% CI: -2.20, -0.35, P < 0.05) were 0.69, 0.61, and -1.27, respectively. TEA was also associated with significant reduction of stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P < 0.05) and hospital (MD, -1.51; 95% CI: -3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, -2.06; 95% CI:-2.68, -1.45, P < 0.05). TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

No MeSH data available.


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A Forest plot for the comparison of epidural anesthesia versus control on the pooled endpoint death.
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Fig5: A Forest plot for the comparison of epidural anesthesia versus control on the pooled endpoint death.

Mentions: Among the eligible studies, 12 of them provided the data of mortality. In these RCTs, the TEA intervention was not associated with a significant improvement in mortality. Death in either TEA group or GA group was infrequent. A total of 8 deaths were presented in TEA group and 10 events were reported in GA group. At last, these studies enrolling 2,181 patients were included for the combined analysis. As the measured heterogeneity was not significant, we selected fixed-effects model to perform the analysis. As presented in Figure 5, the application of TEA had an effect on reducing the risk of death with an estimate RR of 0.89, but it was not statistically significant either in short term or in long term (RR, 0.89; 95% CI:0.42, 1.87. P > 0.05).Figure 5


Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials.

Zhang S, Wu X, Guo H, Ma L - Eur. J. Med. Res. (2015)

A Forest plot for the comparison of epidural anesthesia versus control on the pooled endpoint death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4375848&req=5

Fig5: A Forest plot for the comparison of epidural anesthesia versus control on the pooled endpoint death.
Mentions: Among the eligible studies, 12 of them provided the data of mortality. In these RCTs, the TEA intervention was not associated with a significant improvement in mortality. Death in either TEA group or GA group was infrequent. A total of 8 deaths were presented in TEA group and 10 events were reported in GA group. At last, these studies enrolling 2,181 patients were included for the combined analysis. As the measured heterogeneity was not significant, we selected fixed-effects model to perform the analysis. As presented in Figure 5, the application of TEA had an effect on reducing the risk of death with an estimate RR of 0.89, but it was not statistically significant either in short term or in long term (RR, 0.89; 95% CI:0.42, 1.87. P > 0.05).Figure 5

Bottom Line: Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05).TEA was also associated with significant reduction of stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P < 0.05) and hospital (MD, -1.51; 95% CI: -3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, -2.06; 95% CI:-2.68, -1.45, P < 0.05).TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of anesthesiology, General Hospital of Beijing military region PLA, Beijing, 100010, China. bzmzk@sohu.com.

ABSTRACT
To assess the efficacy of thoracic epidural anesthesia (TEA) with or without general anesthesia (GA) versus GA in patients who underwent cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of Science were searched with the limit of randomized controlled trials (RCTs) relevant to 'thoracic epidural anesthesia' and 'cardiac surgery'. Studies were identified and data were extracted by two reviewers independently. The quality of included studies was also assessed according to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory functions, and treatment-associated complications were pooled and analyzed. The comprehensive search yielded 2,230 citations, and 25 of them enrolling 3,062 participants were included according to the inclusion criteria. Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05). With regard to treatment-related complications, the pooled results for respiratory complications (risk ratio (RR), 0.69; 95% CI: 0.51, 0.91, P < 0.05), supraventricular arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P < 0.05), and pain (mean difference (MD), -1.27; 95% CI: -2.20, -0.35, P < 0.05) were 0.69, 0.61, and -1.27, respectively. TEA was also associated with significant reduction of stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P < 0.05) and hospital (MD, -1.51; 95% CI: -3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, -2.06; 95% CI:-2.68, -1.45, P < 0.05). TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

No MeSH data available.


Related in: MedlinePlus