Comparative Effect of Propofol and Volatile Anesthetics on Postoperative Pulmonary Complications After Lung Resection Surgery: A Randomized Clinical Trial

Abstract

BACKGROUND: The effect of general anesthetics (propofol and volatile anesthetics) on pulmonary outcome after lung resection surgery with one-lung ventilation (OLV) is yet undetermined. We evaluated the effect of intravenous anesthesia (propofol) and volatile anesthesia (sevoflurane or desflurane) regimens on postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. METHODS: This prospective, randomized controlled trial enrolled 555 adult patients scheduled for lung resection surgery with OLV. Participants were randomized to 1 of 3 general anesthetic regimens (propofol, sevoflurane, or desflurane). Standard anesthesia and ventilation protocols were followed in all groups. The primary outcome was a composite of PPCs in the first 7 postoperative days. Secondary outcomes included the severity of PPCs and major postoperative complications classification. Intergroup difference in the primary outcome was assessed for significance using the Pearson χ2 test. RESULTS: Of 837 patients who were assessed for eligibility, 555 were randomized and 545 were analyzed. One hundred and seventy-nine patients were assigned to the propofol group, 182 in the sevoflurane group, and 184 in the desflurane group. The incidence of PPCs did not differ between the combined volatile anesthetics (sevoflurane and desflurane) group and the propofol group (21.9% vs 24.0%; odds ratio, 0.89; 95% confidence interval, 0.58-1.35; P = .570). The PPCs grade and Clavien-Dindo scores did not differ significantly across groups. CONCLUSIONS: In patients undergoing lung resection surgery with OLV, general anesthesia with volatile anesthetics (sevoflurane or desflurane) did not reduce PPCs compared with propofol. No difference in secondary outcomes was observed.

Effects of Intravenous and Inhaled Anesthetics on the Postoperative Complications for the patients undergoing One Lung Ventilation

“…In the present analysis, we included 13 eligible trials (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) with 2522 patients who underwent OLV to illustrate that compared to intravenous anesthetics, inhaled anesthetics were associated with fewer risk of PPCs with the high evidence evaluated by GRADEpro system. However, different types of anesthetics had no significantly different effect on the major complications, postoperative MMSE scores, length of hospital stay or 30-days mortality.…”

“…Within the full text screening we excluded 46 studies (10 articles were not RCT, 19 studies did not match the population criteria, 9 compared intravenous anesthetics to regional anesthesia or other drugs, and 9 studies did not report any outcome as listed before). Finally, we included 13 studies and meta-analyzed the data (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The flow chart was presented in Fig.…”

“…Seven RCTs (14,15,(17)(18)(19)(20)24) compared the effect of intravenous and inhaled anesthetics on PPCs in 763 patients with OLV. The fixed effects model depicted that compared to intravenous anesthetics, inhaled anesthetics significantly reduced the number of patients who had PPCs with low heterogeneity (OR 0.62, 95%CI 0.44 to 0.87, p=0.005; I 2 =37%, Fig.…”

“…Two out of five studies (15,(17)(18)(19)24) which intended to assess the mortality within 30 days after surgery and found that there has no difference in 30-days mortality between two groups (SMD 0.79, 95%CI 0.03 to 18, p=0.88; I 2 =63%, Fig. 7.).…”

“…Five studies (13,15,17,18,24) assessed the major complications post-surgery including 1083 patients, among which fixed effects model showed that there have no significantly difference between intravenous or inhaled anesthetics groups (OR 0.78, 95%CI 0.54 to 1.13, p=0.19; I 2 =0, Fig. 3.…”