Volatile anesthesia did not significantly reduce postoperative delirium compared to IV anesthesia in cardiac valve surgery

CHINA: Anesthesia maintenance with a volatile drug did not lead to substantially fewer instances of postoperative delirium among patients having on-pump heart valve surgery than propofol-based total intravenous anesthesia (TIVA), states a study published in the journal, Anesthesia & Analgesia.

After heart surgery, delirium is a frequent neurologic consequence. In the weeks following heart surgery, delirium might affect up to 52% of patients. Postoperative delirium is linked to worse outcomes, including lengthier hospital and intensive care unit stays, higher rates of morbidity and death, impaired long-term cognitive function, diminished physical capacity, and higher health care expenses. It is yet unknown how different anesthetic regimens affect postoperative delirium following on-pump heart valve surgery.

The purpose of this study was to examine the impact of volatile anesthesia and total intravenous anesthesia (TIVA) based on propofol on the occurrence of delirium following on-pump heart surgery.

To accomplish this objective, from February 2019 through January 2021, this randomized clinical trial was carried out at a university academic hospital in China. Patients were randomized to undergo anesthesia maintenance either with a volatile anesthetic (sevoflurane or desflurane) or a propofol-based TIVA for on-pump cardiac valve surgery or combination valve with coronary artery bypass grafting (CABG) procedures. The main result was the incidence of delirium in the first seven days following surgery, which was measured using the intensive care unit's confusion assessment approach. The secondary endpoints were delirium duration, delirium subtypes, 30-day mortality, pain score, significant morbidity (such as cerebral infarction, respiratory failure, and pneumonia), period of mechanical ventilation, and lengths of ICU and hospital stays. The main outcome variable was statistically analyzed by Pearson's χ2 test. The primary outcome was evaluated on 676 of the 684 patients examined (mean age, 53.8 years; 381 [55.7%] women).

Conclusive results of the study:

• In comparison to patients receiving propofol-based TIVA, postoperative delirium was reported in 76 of 339 (22.4%) patients compared to 63 of 337 (18.7%) patients receiving volatile anesthetic (relative risk, 0.80; 95% confidence interval [CI], 0.55-1.16; P =.231).
• None of the secondary outcomes showed a difference between the groups that was statistically significant.

The authors concluded that in heart valve surgery, volatile anaesthetic did not significantly lessen postoperative delirium compared to IV anesthesia.

REFERENCE

Jiang, Jia-Li MD*; Zhang, Lu MD*; He, Lei-Lei MD†; Yu, Hong MD*; Li, Xue-Fei MD*; Dai, Shun-Hui BSN*; Yu, Hai MD, PhD*. Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial. Anesthesia & Analgesia: October 27, 2022 - Volume - Issue - 10.1213/ANE.0000000000006257 doi: 10.1213/ANE.0000000000006257