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 0.4Â mcg/kg/min, titrating to antihypertensive effect to a max dose of 8Â 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 30Â days, primary outcome) |
Boyd, 1993 | Major surgery, 107 | Dopexamine infusion to achieve oxygen delivery (DO2I) of greater than 600Â mL/min/m2, perioperatively, in high-risk patients. Usual care | Preoperative, intraoperative, postoperative 24Â 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 7Â days (7Â days recommended). No treatment | Intraoperative, postoperative Every day for a time period | Decreased mortality (mortality at 90Â days, primary outcome) |
Fergusson, 2008 | Cardiac, 2331 | Aprotinin: test dose of 40,000Â 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 500,000Â 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 30Â days, secondary outcome) |
Giakoumidakis, 2013 | Cardiac, 200 | Group 1 received aspirin preoperatively while in group 2, aspirin was stopped at least 7Â days before CABG. No treatment | Preoperative Once | Decreased mortality (in-hospital mortality, primary outcome) |
Hase, 2013 | Cardiac, 350 | Bolus of sodium bicarbonate (0.5Â mmol/kg in 250Â mL over 1Â h) at induction followed by an infusion over the next 23Â h (0.2Â mmol/kg/h in 1000Â mL). | Intraoperative, postoperative 24Â h | Increased mortality (death in-hospital, secondary outcome) ND (death at 90Â 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 20Â mg once daily Group B: patients with metoprolol postoperative 200Â 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 85Â 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 150Â mg/dL. Subcutaneous insulin was injected every 4Â h in a directed attempt to maintain blood glucose levels below 200Â 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 (180Â mg in a 1-h preoperative loading dose, then 40Â mg/h over 24Â h and 20Â mg/h over the subsequent 24Â 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 6Â 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 3Â mcg/kg/min or 5Â 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 | 0.2Â 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 0.2Â 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: 4Â 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) |