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Article of the Month – March 2019

The first ever endorsed study by EACTA.
Congratulations to Giovani Landoni and to the EACTA team!

Article: Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

URL: https://www.nejm.org/doi/full/10.1056/NEJMoa1816476?query=featured_home

Please note that you have to register to the NEJM website in order to have access to 3 FREE subscriber-only articles each month.

DOI: 10.1056/NEJMoa1816476

Published: New England Journal of Medicine: March 2019 – Volume 380 – Pages 1214- 1225

Authors:  G. Landoni, V.V. Lomivorotov, C. Nigro Neto, F. Monaco, V.V. Pasyuga, N. Bradic, R. Lembo, G. Gazivoda, V.V. Likhvantsev, C. Lei, A. Lozovskiy, N. Di Tomasso, N.A.R. Bukamal, F.S. Silva, A.E. Bautin, J. Ma, M. Crivellari, A.M.G.A. Farag, N.S. Uvaliev, C. Carollo, M. Pieri, J. Kunstýř, C.Y. Wang, A. Belletti, L.A. Hajjar, E.V. Grigoryev, F.E. Agrò, H. Riha, M.R. El‑Tahan, A.M. Scandroglio, A.M. Elnakera, M. Baiocchi, P. Navalesi, V.A. Shmyrev, L. Severi, M.A. Hegazy, G. Crescenzi, D.N. Ponomarev, L. Brazzi, R. Arnoni, D.G. Tarasov, M. Jovic, M.G. Calabrò, T. Bove, R. Bellomo, and A. Zangrillo, for the MYRIAD Study Group

Article Description:­­­­

This is a multicentre, pragmatic, single-blind, randomised controlled trial. It was conducted in 36 centres in 13 countries.
A total of 5400 patients scheduled for coronary artery bypass grafting (CABG) were randomly assigned to receive volatile anaesthetics (n = 2709) or total intravenous anaesthesia (n = 2691).
Cardiopulmonary bypass was used in two-thirds of the patients.
The primary outcome was deaths from any cause was seen at 1 year.
The data and safety monitoring board advised that the trial should be stopped for futility at the time of the second interim analysis.


Volatile anaesthetics are known to have cardioprotective properties, which in turn, might have favourable clinical outcomes over TIVA in patients undergoing CABG surgery.
It was a pragmatic trial with no specific drug administration protocol, only volatile OR TIVA with 2.3% crossover between the two techniques to simulate the real practice.
Regarding results, there were no significant difference between groups in mortality from any cause at 1 year (The primary outcome) (2.8% in the volatile anaesthetics group and 3.0% in the total intravenous anaesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71). The data were available for 99.9 % of patients.
Secondary outcomes, also, showed no significant differences including myocardial infarction.


The authors concluded the safety of general anaesthesia by either technique (volatile anaesthetics and TIVA) for patients undergoing CABG.

Tell us: which is your routine anaesthesia technique during CABG surgery?
We look forward to receiving your valuable comments!

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