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Table 3 Summary of mortality outcome for pharmacotherapy interventions for a significant difference in mortality

From: Anesthesia interventions that alter perioperative mortality: a scoping review

First author, year Type of surgery, no. of participants Intervention/comparison details Perioperative phase, duration of intervention Impact on mortality* (outcome definition, timing)
Aronson, 2008 Cardiac, 1506 IV clevidipine at an initial rate of 0.4 mcg/kg/min, titrating to antihypertensive effect to a max dose of 8 mcg/kg/min.
Three comparator groups of common (usual care) perioperative antihypertensives: nitroglycerin, sodium nitroprusside, and nicardipine.
Preoperative, intraoperative, postoperative
Once
Decreased mortality (death at 30 days, primary outcome)
Boyd, 1993 Major surgery, 107 Dopexamine infusion to achieve oxygen delivery (DO2I) of greater than 600 mL/min/m2, perioperatively, in high-risk patients.
Usual care
Preoperative, intraoperative, postoperative
24 h
Decreased mortality (in-hospital mortality, primary outcome)
Comerota, 1993 Vascular, 134 One of three doses of urokinase (125,000, 250,000, or 500,000) infused into the distal circulation before lower extremity bypass for chronic limb ischemia
No treatment
Intraoperative
Once
Increased mortality (death at NR, secondary outcome)
Devereaux, 2008 Non-cardiac, 8351 Extended-release metoprolol 2–4 h before surgery and continued for 30 days
Placebo
Preoperative, postoperative
Once
Increased mortality (cardiovascular death, NR, primary outcome)
Donato, 2007 Vascular, 192 Iloprost (intra-arterial, intraoperative bolus) of 3000 ng, plus intravenous infusion of 0.5–2.0 ng/kg/min.
No treatment
Intraoperative, postoperative
Every day for a time period
Decreased mortality (mortality at 90 days, primary outcome)
Donato, 2006 Vascular, 300 Starting from the first day after surgery, a daily 6-h intravenous infusion of iloprost (or placebo) at doses recommended for chronic critical limb ischemia was performed for 4 to 7 days (7 days recommended).
No treatment
Intraoperative, postoperative
Every day for a time period
Decreased mortality (mortality at 90 days, primary outcome)
Fergusson, 2008 Cardiac, 2331 Aprotinin: test dose of 40,000 KIU administered during a 10-min period after insertion of central venous line and induction of anesthesia. If no anaphylactic reaction remained for loading dose (1.96 million KIU) given followed by maintenance infusion of 500,000 KIU/h and maintained during surgery.
Aminocaproic acid or tranexamic acid
Intraoperative
During most of the intraoperative period
Increased mortality (death from all causes at 30 days, secondary outcome)
Giakoumidakis, 2013 Cardiac, 200 Group 1 received aspirin preoperatively while in group 2, aspirin was stopped at least 7 days before CABG.
No treatment
Preoperative
Once
Decreased mortality (in-hospital mortality, primary outcome)
Hase, 2013 Cardiac, 350 Bolus of sodium bicarbonate (0.5 mmol/kg in 250 mL over 1 h) at induction followed by an infusion over the next 23 h (0.2 mmol/kg/h in 1000 mL). Intraoperative, postoperative
24 h
Increased mortality (death in-hospital, secondary outcome)
ND (death at 90 days, secondary outcome)
Herr, 2000 NR, 113 Propofol or propofol plus EDTA Intraoperative
Once
Increased mortality (7-day mortality, primary outcome)
Iliuta, 2009 Cardiac, 1352 Group A: patients with betaxolol postoperative 20 mg once daily
Group B: patients with metoprolol postoperative 200 mg in two equal doses daily
Preoperative, intraoperative postoperative, after discharge from hospital
Every day for a time period
Decreased mortality (30-day mortality, primary outcome)
Illiuta, 2003 Cardiac, 400 Patients received nadroparin 85 U/kg SC q12h.
Usual care: patients received unfractionated heparin IV to maintain APTT at 2.5 the normal value.
Postoperative
Every day for a time period
Decreased mortality (30-day mortality, primary outcome)
Kirdemir, 2008 Cardiac, 200 Continuous insulin infusion titrated per protocol in the perioperative period (Portland protocol) to maintain blood glucose between 100 and 150 mg/dL.
Subcutaneous insulin was injected every 4 h in a directed attempt to maintain blood glucose levels below 200 mg/dL.
Intraoperative, postoperative
Immediately preoperatively until postop day 3
Decreased mortality (in-hospital mortality, secondary outcome)
Krestchmer, 1989 Vascular, 252 ASA (1–1.5 g daily)
No treatment
Preoperative, postoperative, after discharge from hospital
Every day for a time period
Decreased mortality (probability of survival at 6 years, primary outcome)
Levin, 2012 Cardiac, 93 Preoperative loading dose of levosimendan (10 μg/kg over 60 min) followed by a continuous 23 h infusion of 0.1 μg/kg/min
No treatment
Preoperative
Every day for a time period
Decreased mortality (30-day mortality, primary outcome)
Levin, 2008 Cardiac, 252 Preoperative loading dose of levosimendan (10 μg/kg over 60 min) followed by a continuous 23 h infusion of 0.1 μg/kg/min
No treatment
Preoperative, intraoperative
Every day for a time period
Decreased mortality (30-day mortality, primary outcome)
Mentzer, 2008 Cardiac, 5761 Intravenous cariporide (180 mg in a 1-h preoperative loading dose, then 40 mg/h over 24 h and 20 mg/h over the subsequent 24 h).
No treatment
Preoperative Increased mortality (all-cause mortality at day 5, secondary outcome)
Increased mortality (all-cause mortality at day 30, secondary outcome)
ND (all-cause mortality at 6 months, secondary outcome)
Norman, 2009 Thoracic, 16 Aprotinin (IV bonus of 2 million KIU followed by a 0.5 million KIU per but infusion).
No treatment
Intraoperative
Once
Decreased mortality (survival at NR, secondary outcome)
Poldermans, 1999* Vascular, 112 Beta-blockade with bisoprolol
Usual care with no perioperative blockade
Preoperative, intraoperative postoperative
Until surgery
Decreased mortality (perioperative death, primary outcome)
Reyad, 2013 General, 60 Dobutamine at either 3 mcg/kg/min or 5 mcg/kg/min.
No treatment
Intraoperative
During most of the intraoperative phase
Decreased mortality (death in-hospital, secondary outcome)
Turpie, 2007 General, 467 Injections of fondaparinux 2.5 mg (fondaparinux sodium, Arixtra, GlaxoSmithKline, Research Triangle Park, NC, USA).
No treatment
Postoperative
Every day for a time period: daily for 5–9 days
Decreased mortality (death at 30 days, secondary outcome)
Wallace, 2004 General, 190 0.2 mg oral tablet of clonidine (Catapres; Boehringer Ingelheim, Ridgefield, CT), a 7.0-cm2 transdermal patch of clonidine (Catapres-TTS-2; Boehringer Ingelheim), providing continuous systemic delivery of 0.2 mg/day, and an oral loading dose of clonidine, 0.2-mg tablet (Catapres).
No treatment
Preoperative, intraoperative, postoperative
Every day for a time period: 4 days
Decreased mortality (30-day mortality, NR)
Decreased mortality (2-year mortality, NR)
Wilson, 1999 General, 138 1 L of Hartmann’s solution during line insertion. Human albumin solution 4.5% was then infused until a pulmonary artery occlusion pressure of 12 mmHg was achieved. If hemoglobin concentration was < 110 g/L, red blood cells were transfused instead of the albumin solution. If oxygen saturation was < 94%, supplemental oxygen was provided. Inotrope was commenced at a rate (mL/h) calculated from a chart according to the patient’s weight and equated to 0.025 ìg/kg/min for adrenaline. The infusion was increased by single multiples of the initial rate until the target oxygen delivery of > 600 ml/min/m2 was achieved or the onset of side effects was noted (increase in heart rate > 30% above baseline or development of chest pain or a new dysrhythmia). All patients were started on the study inotrope even if the target oxygen delivery had been achieved after the fluid phase.
Usual care
Preoperative, intraoperative, postoperative
Minimum of 4 h before surgery, continued for at least 12 h afterwards.
Decreased mortality (in-hospital mortality, primary outcome)
  1. Anesthesia-related intervention refers to the interventions provided in the perioperative period that was or could be performed, organized, or initiated by a healthcare professional with specific training in anesthesia
  2. ND no significant change, NR not reported
  3. *This study was part of an investigation of academic integrity. The investigating committee was unable to confirm or deny any doubts surrounding the conduct of the study, and it thus not retracted from the journal where it was published. We therefore did not exclude the study from our scoping review