Evidence map›Paper›PMID 27465213›Full record

Trial reportCanadian journal of anaesthesia = Journal canadien d'anesthesie2016

Comparison of isoflurane and sevoflurane in cardiac surgery: a randomized non-inferiority comparative effectiveness trial.

Philip M Jones, Daniel Bainbridge, Michael W A Chu, Philip S Fernandes, Stephanie A Fox, Ivan Iglesias, Bob Kiaii, Ronit Lavi, John M Murkin

2 registry-linked trialsOpen access · hybridAbstract readComparative StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
3.8field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01477151 phase4completednot on this map

Randomized Isoflurane and Sevoflurane Comparison in Cardiac Surgery: A Prospective Randomized Clinical Trial.

TypeinterventionalSponsorLondon Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sRan2011 to 2015Enrolled464ConditionsCoronary Artery Disease, Valvular Heart DiseaseArmsVolatile anesthetic
NCT03420586 nacompletednot on this mapstarted 2018, after this paper: background citation

Effects of Nitrous Oxide Added at the End of Sevoflurane Anesthesia on Recovery and Postoperative Nausea and Vomiting - a Randomized Clinical Trial (SEVONATE)

TypeinterventionalSponsorGeneral Hospital ZadarRan2018 to 2021Enrolled100ConditionsElective Surgical Procedures, Laparoscopy, Laparotomy, Anesthesia, GeneralArmsNitrous Oxide
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Philip M JonesDepartment of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada. philip.jones@lhsc.on.ca.
Daniel BainbridgeDepartment of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Michael W A ChuDivision of Cardiac Surgery, Department of Surgery, The University of Western Ontario, London, ON, Canada.
Philip S FernandesClinical Perfusion Services, Cardiac Care, London Health Sciences Centre, London, ON, Canada.
Stephanie A FoxDivision of Cardiac Surgery, Department of Surgery, The University of Western Ontario, London, ON, Canada.
Ivan IglesiasDepartment of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Bob KiaiiDivision of Cardiac Surgery, Department of Surgery, The University of Western Ontario, London, ON, Canada.
Ronit LaviDepartment of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.
John M MurkinDepartment of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Western University · CALondon Health Sciences Centre · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeVolatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was non-inferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery.

methodsThis was a pragmatic randomized non-inferiority comparative effectiveness clinical trial in 464 adults having coronary artery bypass graft and/or single valve surgery during November 2011 to March 2014. The intervention was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n = 233) administered at a dose of 0.5-2.0 MAC throughout the entire operation. All caregivers were blinded except for the anesthesiologist and perfusionist. The primary outcome was a composite of intensive care unit (ICU) length of stay ≥ 48 hr and all-cause 30-day mortality. We hypothesized that sevoflurane would be non-inferior to isoflurane (non-inferiority margin < 10% based on an expected event rate of 25%). Secondary outcomes included prolonged ICU stay, 30- and 365-day all-cause mortality, inotrope or vasopressor usage, new-onset hemodialysis or atrial fibrillation, stroke, and readmission to the ICU.

resultsNo losses to follow-up occurred. The primary outcome occurred in 25% of sevoflurane patients and 30% of isoflurane patients (absolute difference, -5.4%; one-sided 95% confidence interval, 1.4), thus non-inferiority was declared. Sevoflurane was not superior to isoflurane for the primary outcome (P = 0.21) or for any secondary outcomes.

conclusionSevoflurane is non-inferior to isoflurane on a composite outcome of prolonged ICU stay and all-cause 30-day mortality. Sevoflurane is not superior to isoflurane on any other of the clinically important outcomes. This trial was registered at clinicaltrials.gov; NCT01477151.

Indexed as

Anesthetics, InhalationAdultAgedCardiac Surgical ProceduresCardiotonic AgentsComparative Effectiveness ResearchCoronary Artery BypassCritical CareFemaleHumansIsofluraneKaplan-Meier EstimateLength of StayMaleMethyl EthersMiddle AgedAnesthetics, InhalationCardiotonic AgentsIsofluraneMethyl EthersSevofluraneVasoconstrictor Agents

Identifiers

PMID27465213
PMCPMC5023754
OpenAlexW2482734106

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.