Материалы и методы

rmt

Общая реаниматология

General Reanimatology

1813-97792411-7110

FSBI "SRIGR" RAMS

10.15360/1813-9779-2020-6-91-104

rmt-1988

Research Article

ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ

REVIEWS & SHORT COMMUNICATIONS

Ингаляционная vs тотальная внутривенная анестезия: где маятник сейчас? (мета-анализ и обзор)

Inhalation vs Total Intravenous Anesthesia in Cancer Surgery: Where is the «Pendulum» Now? (Meta-Analysis and Review)

Лихванцев

В. В.

Likhvantsev

Валерий Владимирович Лихванцев

107031, Москва, ул. Петровка, д. 25, стр. 2

25 Petrovka Str., Build. 2, 107031 Moscow

lik0704@gmail.com

Ядгаров

М. Я.

Yadgarov

107031, Москва, ул. Петровка, д. 25, стр. 2;

25 Petrovka Str., Build. 2, 107031 Moscow

Di Piazza

Отдел анестезиологии и интенсивной терапии.

60 Виа Олгиттина, 20132, Милан

Department of Anesthesia and Intensive Care.

Via Olgettina, 60, 20132, Milan

Каданцева

К. К.

Kadantseva

107031, Москва, ул. Петровка, д. 25, стр. 2;

25 Petrovka Str., Build. 2, 107031 Moscow

НИИ Общей реаниматологии им. В.А. Неговского ФНКЦ РРРоссияV.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation

Научный институт Сан-РафаэлеИталияIRCCS San Raffaele Scientific InstituteItaly

2020

30122020

16691104

2020

Лихванцев В.В., Ядгаров М.Я., Di Piazza M., Каданцева К.К.

Likhvantsev V., Yadgarov M., Di Piazza M., Kadantseva K.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.reanimatology.com/rmt/article/view/1988

Многие годы с переменным успехом продолжаются сравнительные исследования эффективности и безопасности ингаляционной и тотальной внутривенной анестезий (ИА и ТВА, соответственно), включая проблему значимости феномена анестетической органопротекции в клинике.

Цель исследования — оценка новых данных относительно клинической эффективности анестетического прекондиционирования и проблемы выбора между ингаляционной и внутривенной анестезией.

Материалы и методы

Материалы и методы. Данный системный обзор и мета-анализ выполнили в соответствие с рекомендациями «Предпочтительных элементов отчетности для систематических обзоров и руководящих принципов мета-анализа» (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) на основании поиска и анализа литературы за последние пять лет.

Результаты

Результаты. При первоначальном поиске в базе данных PubMed отобрали 759 статей. Под критерии поиска подошли 13 публикаций, включая 10 исследований — сравнений ТВА и ИА у пациентов, оперируемых по поводу злокачественных заболеваний и 3 исследования, посвященные клинической значимости анестетической кардиопротекции.

Анализ двух мета-анализов и одного мульти-регионального клинического исследования (МРКИ) подвиг авторов к заключению о тщетности дальнейших поисков доказательств эффективности анестетической кардиопротекции в клинике. Вместе с тем, мета-анализ 9-ти ретроспективных когортных исследований и 1-го МРКИ выявил негативное влияние ИА на 3-х летнюю летальность в хирургической онкологии; показатели составили: Total Hazard Ratio (HR) -1,73 (1,36; 1,96), характеристики гетерогенности — Q = 8,336, df = 3, I2; f2= 64,01; анализ общего эффекта — Z = 2,386 (p<0,017). Анализ пятилетней летальности различий не выявил, однако и не снял сомнений относительно возможных ограничений на использование ИА в данной области хирургии.

Заключение

Заключение. Авторы предлагают прекратить исследования, направленные на поиск доказательств эффективности анестетической кардиопротекции в клинике ввиду тщетности предпринимаемых усилий. Вместе с тем, некоторые, преимущественно, когортные исследования указывают на наличие серьезной проблемы на пути дальнейшего использования ингаляционной анестезии в хирургической онкологии. Авторы считают необходимым проведение серьезного сравнительного МРКИ в данном направлении.

Comparative studies on the efficacy and safety of Inhalation Anesthesia (IA) and Total IntraVenous Anesthesia (TIVA) have been performed for many years, and the results were various.

The aim of this study was to evaluate new data on the clinical efficacy of anesthetic preconditioning, the difference between inhalation and intravenous anesthesia on cardiac protection and clinically relevant outcomes in cancer surgery.

Materials and methods

Materials and methods. We carried out a systematic review and meta-analysis on searches and analysis of the literature over the past five years in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Results. Out of the 759 articles which were initially identified, we selected 3 studies regarding the clinical significance of anesthetic cardioprotection and 10 studies comparing IA and TIVA in patients undergoing surgery for malignant diseases.

Two meta-analyses and one multi-regional clinical trial (MRCT) suggest that further studies of the effectiveness of anesthetic cardioprotection is futile.

A meta-analysis of 9 retrospective cohort studies and 1 MRCT showed a detrimental effect of IA on 3-year survival in surgical oncology (Hazard Ratio (HR): 1.73 (1.36; 1.96) Heterogeneity: Q = 8.336, df = 3, I2; f2= 64.01, overall effect analysis: Z = 2.386 (P<0.017)). Analysis of 5-year mortality did not reveal any differences, although it did not remove any doubts about the possible negative effect of the use of IA in surgical oncology.

Conclusion

Conclusion. Due to the futility of the previous efforts, the authors suggest not starting new studies aimed at finding evidence of the effectiveness of anesthetic cardioprotection on clinically relevant outcomes. However, since cohort studies indicate a possible beneficial effect of the use of TIVA in surgical oncology, the authors suggest conducting a serious comparative MRCT in this setting.

исходы анестезиипериоперационая смертностьингаляционная анестезиявнутривенная анестезияанестезия онкологических пациентованестетическое прекондиционирование

anesthesia related outcomesperioperative mortalityvolatile anesthesia vs TIVAanesthesia for cancer patientsanesthetic preconditioning

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The authors declare that there are no conflicts of interest present.