BackgroundThe benefit of volatile anesthetics in coronary artery bypass grafting (CABG) patients remains controversial. We aim to conduct an updated meta-analysis to assess whether the use of volatile anesthetics during CABG could reduce mortality as well as other outcomes.MethodsWe searched eight databases from inception to June 2019. RCTs comparing the effects of volatile anesthetics versus total intravenous anesthesia (TIVA) in CABG patients were included. The primary outcomes were operative mortality and one-year mortality. The second outcomes included length of stay in intensive care unit (ICU), length of stay in hospital, and postoperative safety outcomes (myocardial infarction, heart failure, arrhythmia, stroke, delirium, postoperative cognitive impairment, acute kidney injury, and the use of intra-aortic balloon pump (IABP) or other mechanical circulatory support). Trial sequential analysis (TSA) was performed to control random errors. ResultsThis updated meta-analysis will test the hypothesis that the use of volatile anesthetics during CABG would not result in a lower mortality than TIVA. We also aim to examine the effect of volatile anesthetics on length of stay in intensive care unit (ICU), length of stay in hospital, and other postoperative safety outcomes. Moreover, we use trial sequential analysis (TSA) to determine whether the currently available evidence is sufficient and conclusive.ConclusionThis updated meta-analysis may overturn the beneficial effect of volatile anesthetics, impact the choice of anesthesia for thousands of CABG patients, and further alter current guideline recommendations regarding this issue.