Abstract 4373550: Efficacy and Safety of Sedative Hypnotic Induction Agents on Perioperative Outcomes in Coronary Artery Bypass Grafting: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Choice of sedative–hypnotic agents can affect intraoperative and postoperative outcomes; however, comparative studies in adult coronary artery bypass grafting (CABG) are limited. Methods: We conducted a Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) directly comparing two or more sedative–hypnotic agents in adult CABG patients, using PubMed, EMBASE, and the Cochrane Library through May 2025. Propofol served as the reference comparator for all outcomes except troponin release, where the control arm was used. Data were analyzed with R software (v4.4.3) using Surface Under the Cumulative Ranking (SUCRA) curves and rankograms. Higher SUCRA values indicate a greater likelihood of increased effect. Outcomes included mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), troponin release, and intensive care unit (ICU) stay, and are reported as mean difference (MD) with 95% credible interval (CrI). Results: Twelve RCTs comprising 26 arms were included. Etomidate (SUCRA 0.806; MD 26 mmHg; 95% CrI −8.8 to 60.0) and thiopentone sodium (0.748; MD 25 mmHg; 95% CrI −23 to 72) showed the greatest increase in MAP from baseline. Post-intervention MAP was highest with diazepam (0.770; MD 17 mmHg; 95% CrI −4.9 to 39.0) and etomidate (0.690; MD 13 mmHg; 95% CrI −3.8 to 30.0). For post-intervention HR, control (0.900) and thiopentone (0.810) ranked highest, while only sevoflurane significantly reduced HR versus propofol (MD −10 bpm; 95% CrI −19 to −0.35). Thiopentone (0.848; MD 11 bpm; 95% CrI −13 to 36) and midazolam (0.612; MD 4.2 bpm; 95% CrI −14 to 22) had the greatest changes in HR from baseline, whereas etomidate (0.302) had the smallest. Diazepam led SBP (0.769; MD 28 mmHg; 95% CrI −8.2 to 65.0). Troponin release did not differ significantly, though isoflurane reduced levels versus control (MD −2.9 ng/mL; 95% CrI −6.1 to 0.51). Dexmedetomidine was linked to longer ICU stays (MD 12 h; 95% CrI −21 to 45). Node-splitting analysis indicated no inconsistency between direct and indirect comparisons. Conclusion: Etomidate provided the greatest hemodynamic stability in MAP and HR measures, while sevoflurane was the sole agent to significantly reduce HR. No significant differences were observed for SBP, troponin release, or ICU stay duration. These findings can inform anesthetic selection to optimize cardiovascular stability during CABG.