OBJECTIVE: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. DESIGN: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. SETTING: Tertiary and University hospitals. INTERVENTIONS: Patients (n=10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. MEASUREMENTS AND MAIN RESULTS: The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. CONCLUSIONS: The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.

Anaesthesia and Intensive Care Hospital Pulau Pinang Georgetown Malaysia

Anaesthesia and Intensive Care University of Malaya Kuala Lumpur Malaysia

Anaesthesia Intensive Care and Pain Management Department University School of Medicine Campus Bio Medico Rome Italy

Anestesia e Terapia Intensiva Cardiochirurgica Humanitas Research Hospital Rozzano Italy

Anesthesia and Intensive Care Azienda Ospedaliera San Camillo Forlanini Roma Italy

Anesthesia and Intensive Care Dipartimento Scienze Mediche e Chirurgiche Università della Magna Graecia Catanzaro Italy

Anesthesia and Intensive Care Faculty of Medicine Zagazig University Zagazig Egypt

Anesthesia and Intensive care Heart Institute University of Sao Paulo Sao Paulo Brazil

Anesthesia and Intensive Care S Orsola Malpighi University Hospital Bologna Italy

Anesthesia Section of Cardiothoracic Surgery Dante Pazzanese Institute of Cardiology Sao Paulo Brazil

Anesthesiology and Intensive Care Department Moscow Clinical Regional Research Institute Shepkina st 61 2 Moscow Russia

Anesthetic Department Hospital de Santa Maria Lisboa Portugal

Cardiac Anesthesia and Intensive Care Unit Monaldi Hospital A O R N Dei Colli Via L Bianchi Naples 80131 Italy

Cardiothoracic Anaesthesia and Surgical Intensive Care King Fahd Hospital University of Dammam Al Khobar Saudi Arabia

Cardiothoracic Anesthesiology and Intensive Care Institute for Clinical and Experimental Medicine Prague Czech Republic

Cardiothoracic ICU and Anaesthesia MKCC West Riffa Bahrain

Center for Anesthesiology Beijing Anzhen Hospital Capital Medical University Beijing China

Department Anesthesia and Intensive Care ACIBADEM City Clinic Burgas Burgas Bulgaria

Department of Anaesthesia and Critical Care Medicine Azienda Ospedaliero Universitaria Pisana Via Paradisa 2 56123 Pisa Italy

Department of Anaesthesia and Intensive Care King Abdullah Medical City in Holy Capital KAMC HC Makkah Saudi Arabia

Department of Anaesthesia and Intensive Care Siberian Biomedical Research Center of the Ministry of Health Novosibirsk Russia

Department of Anaesthesiology and Intensive Care Sarawak General Hospital Kuching Sarawak Malaysia

Department of Anaesthetics King's College Hospital NHS Foundation Trust London United Kingdom

Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Via Olgettina 60 Milan 20132 Italy

Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Prague Prague Czech Republic

Department of Anesthesiology and Intensive Care Cardiovascular Institute `Dedinje` Belgrade Serbia

Department of Anesthesiology and Intensive Care Federal Almazov North West Medical Research Centre Saint Petersburg Russia

Department of Anesthesiology and Intensive Care Ural Institute of Cardiology Ekaterinburg Russia

Department of Anesthesiology and Perioperative Medicine 1st Affiliative Hospital 4th Military Medical University Xi'an China

Department of Anesthesiology Qilu Hospital of Shandong University Shandong China

Department of Anesthesiology The 2nd Xiangya Hospital of Central South University Changsha China

Department of Anesthesiology Wuhan Asia Heart Hospital Wuhan China

Department of Cardiac Aneasthesia and Intensive Care Astrakhan Federal Centre for Cardiac Surgery Astrakhan Russia

Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine University Hospital Dubrava Zagreb Croatia

Department of Medicine Anesthesia and Intensive Care Unit Padova University Hospital Via Cesare Battisti 256 35128 Padova Italy

Department of Medico Surgical Sciences and Biotechnologies Sapienza University of Rome Latina Italy; Department of AngioCardioNeurology IRCCS Neuromed Pozzilli Italy

Department of Surgery Level 6 Clinical Medical Research Building The University of Melbourne Melbourne Australia

Deputy Director for Clinical and Scientific Affairs Scientific Research Institute of Complex Issues of Cardiovascular Disease Kemerovo Russia

Dipartimento Cardiotoracico Azienda Ospedaliera Spedali Civili Brescia Italy

Siberian Biomedical Research Center Department of Anesthesiology and Intensive Care Novosibirsk Russia

The University of Melbourne Melbourne Victoria Australia

University of Bristol School of Clinical Sciences Bristol Heart Institute Bristol United Kingdom

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