Técnicas anestésicas neuroaxiales asociadas con anestesia general en procedimientos quirúrgicos cardíacos. Revisión sistemática y Metanálisis Neuraxial anesthetics techniques associated with general anesthesia in car- diac surgery. Systematic review and metaanalysis

Introduction: The systematic review associated by meta-analysis offers potential information about the effects of therapeutics me- thods and constitutes the methodologies guidelines for the evaluation of them. Objective: We performed this study to evaluate the benefits of neuraxial anesthetics techniques associated with general anesthe- sia, in the perioperative evolution of patients undergoing cardiac surgery. Method: The randomized controlled trials published between January 2004 and February 2011 were included. The systematic review was made using recommended guidelines from the Cochrane collaborations management system. In the meta- analysis for dichotomous outcomes the odds ratios and relative risk were calculated and for continuous outcomes the means differences was evaluated. Also the heterogeneity between the studies was analyzed and the sensibility analysis was made. Results: 24 trials, enrolling 2 388 patients were included. The association of neuraxial anesthetics techniques with general anes- thesia reduces the risk of pulmonary complications, the opiods consumption, the time of tracheal extubation and the hospital stay. Referent to intensive care unit stay and cardiac morbidity, the differences were lesser. The risk of spinal hematoma remains uncertain. Conclusions: The association of neuraxial anesthetics techniques with general anesthesia in patients undergoing cardiac surgery improved the perioperative evolution.