Table 1 Characteristics of the included RCTs
Study | Country | Design | Surgical procedure | No. of patients | Mean age years | Male % | Anesthesia regimen | Anesthesia depth monitoring | Protocols of RIPC | Control | Diagnosis of outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|
Jing 2011 | China | R, DB | On-pump valvular surgery | 40 | 49.5 | 37.5 | Midazolam, fentanyl, rocuronium, sevoflurane; | BIS: 40~60 | UL, 260mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | POCD: postoperative performance deteriorated by ≥ 1 SD on ≥ 2 tests in MMSE or MoCA |
Joung 2013 | Korea | R, DB | Off-pump CABG | 70 | 60.0 | 81.4 | Etomidate, propofol, rocuronium, remifentanil; | BIS: 40~60 | UL, 200mmHg, 5min × 4, before coronary artery anastomosis | Uninflated cuff | POCD: decreased postoperative test values of > 20% from the baseline in ≥ 2 tests of the 6 cognitive function tests recommended by STS |
Meybohm 2013 | Germany | R, DB | On-pump heart surgery | 180 | 69.0 | 81.2 | Propofol, rocuronium, sufentanil; | NR | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | POCD: postoperative performance deteriorated by ≥ 1 SD on ≥ 2 tests in core battery of 10 tests recommended by STS |
Hudetz 2015 | USA | R, DB | On-pump heart surgery | 30 | 65.5 | 100 | Midazolam, fentanyl, rocuronium, etomidate, isoflurane; | NR | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | POD: ICDSC score based on DSM-IV criteria; POCD: incidence of ≥ 1-SD decline in a brief neuropsychometric battery |
Meybohm 2015 | Germany | R, DB | On-pump heart surgery | 1385 | 65.9 | 74.2 | Intravenous anesthesia with no volatile anesthetic agents | NR | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | POD: CAM-ICU score |
Brown 2016 | USA | R, DB | On-pump heart surgery | 34 | 74.1 | 58.8 | Midazolam based intravenous anesthesia | NR | UL, 200mmHg, 5min × 3, after anesthesia induction and before CPB | Uninflated cuff | POD: CAM-ICU score |
Kim 2017 | Korea | R, DB | On-pump heart surgery | 160 | 62.3 | 53.1 | Midazolam, sufentanil, vecuronium, propofol; | BIS: 40~60 | UL, 200mmHg, 5min × 4 24~48 hours before surgery | Cuff inflated with 10mmHg pressure | POD: CAM-ICU score |
Meybohm 2018 | Germany | R, DB | On-pump heart surgery | 273 | NR | NR | Intravenous anesthesia with no volatile anesthetic agents | NR | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | POCD: postoperative performance deteriorated ≥ 1 SD on ≥ 2 tests in core battery of 10 tests recommended by STS |
Wang 2019 | China | R, DB | Off-pump CABG | 65 | 60.5 | 73.5 | Midazolam, fentanyl, rocuronium, sevoflurane; | BIS: 40~60 | UL, SBP+40mmHg, 5min × 4, before surgical incision | Uninflated cuff | POD: CAM-ICU score |
Gasparovic 2019 | USA | R, DB | On-pump CABG | 66 | 62.0 | 82.0 | Midazolam, sufentanil, rocuronium, sevoflurane; | NR | UL, 200mmHg, 5min × 3, after anesthesia induction and before CPB | Uninflated cuff | POD: CAM-ICU score; POCD: a decrease of minimally ≥ 1 SD in ≥ 2 postoperative neurocognitive tests by MoCA; |