Author + information
- Giovanni Landoni, MD⁎ (, )
- Oliviero Fochi, MD and
- Alberto Zangrillo, MD
- ↵⁎Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milano, Italia, Via Olgettina 60, Milan 20132, Italy
In the recently published article by Fleisher et al. (1), the authors advise using volatile anesthetics as cardioprotective agents in patients at risk for myocardial ischemia undergoing noncardiac surgery. These drugs have indeed shown marked cardioprotective properties in cardiac surgery, reducing post-operative mortality and myocardial infarction rate when compared with total intravenous anesthesia (2).
No study to date has allowed these interesting results to be translated in noncardiac surgery settings. A recent meta-analysis including more than 80 randomized controlled studies in which volatile anesthetics were compared with total intravenous anesthesia in noncardiac surgery highlighted the complete lack of published randomized clinical trials reporting data regarding postoperative mortality or cardiac complications after noncardiac surgery (3), which indicates that cardioprotection by halogenated anesthetics in noncardiac surgery is a new and interesting subject that deserves further study.
Because the authors of the guidelines suggest a class of evidence IIA, level B (“some conflicting evidence from single randomized trial or non-randomized studies”), we would appreciate knowing which article(s) provided the evidence to state that “it can be beneficial to use volatile anesthetic agents during noncardiac surgery for the maintenance of general anesthesia in hemodynamically stable patients at risk for myocardial ischemia.”
Please note: Dr. Landoni acknowledges receiving modest support (<2,000 €) as a reimbursement for conferences-symposia.
- American College of Cardiology Foundation
- Fleisher L.A.,
- Beckman J.A.,
- Brown K.A.,
- et al.
- Fochi O.,
- Bignami E.,
- Landoni G.,
- et al.