Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery

Background: To evaluate the cardioprotective effects of sevoflurane versus propofol anesthesia in patients undergoing cardiac surgery. Methods: Studies were retrieved through searching several databases. Study quality was evaluated by Jadad scale. Meta-analysis was performed with RevMan5.0 software. Publication bias was tested by funnel plot. Results: As a result, 15 studies were included. Compared with propofol, sevoflurane anesthesia significantly improved postoperative (WMD (weighted mean difference) = 0.62, 95% CI: 0.33 to 0.92; P < 0.0001) and postoperative 12 hour cardiac index (WMD = 0.18, 95% CI: 0.03 to 0.33; P = 0.02), postoperative cardiac output (WMD = 1.14, 95% CI: 0.74 to 1.54; P < 0.00001), and reduced postoperative 24 hour cardiac troponin I concentration (WMD = -0.86, 95% CI:-1.49 to -0.22; P = 0.008), postoperative inotropic drug usage (OR (odds ratio) = 0.31, 95% CI: 0.22 to 0.44; P < 0.00001), vasoconstrictor drug usage (OR = 0.30, 95% CI:0.21 to 0.43; P < 0.00001), ICU stay (WMD = -15.53, 95% CI: -24.29 to -6.58; P = 0.0007) and a trial fibrillation incidence (OR = 0.25, 95% CI: 0.07 to 0.85; P = 0.03). However, no significant differences were found in other indexes. Subgroup analysis indicated the similar results. Discussion: The sevoflurane-induced cTnI reduction is associated with lower incidence of late adverse cardiac events, accounting for its roles in cardiac protection. Several limitations existed such as the small sample size and the lack use of blind design. Conclusions: Sevoflurane may exhibit a more favorable cardioprotective effect during cardiac surgery than propofol.