Effects of Inhalation versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications after Anatomic Pulmonary Resection

Abstract

Background:No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. Methods: This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. Results: The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. Conclusion: Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.

Total intravenous anesthesia shortens hospital stay after lung resection surgery: A propensity score matching study.

“…However, owing to the limited data on LOS in that meta-analysis, this result should be interpreted with caution [14]. In a retrospective study, the TIVA group had a shorter LOS than the volatile anesthesia group; however, this nding may attributed to the lower incidence of prolonged air leakage in the TIVA group [9]. As there is no consensus on the superiority of TIVA or volatile anesthesia in LRS, both regimens are considered equivalent choices in the current recommendations for enhanced recovery after surgery (ERAS) programs [15].…”

“…In a previous retrospective study, no statistically signi cant difference in the incidence of PPCs between the volatile anesthesia and TIVA groups was observed; however, prolonged air leak occurred more frequently in the volatile anesthesia group. This difference between the two groups may have been caused by a change in postoperative care strategy rather than the anesthesia regimens used [9]. In a randomized controlled trial of patients who underwent LRS with prolonged OLV, the TIVA group showed a higher incidence of PPCs and higher 1-year mortality than the volatile anesthesia group [6].…”

Effect of total intravenous versus inhalation anesthesia on long-term oncological outcomes in patients undergoing curative resection for early-stage non-small cell lung cancer: a retrospective cohort study

“…Therefore, anesthetics may affect the outcome of lung cancer surgery. However, the optimal anesthetic for one-lung ventilation and pulmonary resection of lung cancer remains unclear [4,22]. Regarding one-lung ventilation-induced pathophysiology, propofol could be beneficial since it decreases the intraoperative shunt and maintains oxygenation better than inhalation anesthetics.…”

“…properties than propofol [4,23]. Lee et al investigated the short-term prognosis of patients with lung cancer who underwent propofol-based TIVA or inhalation anesthesia for anatomical lung resection [22]. They found that patients who received propofol-based TIVA had shorter hospital and ICU stays as well as chest tube indwelling durations than patients who received inhalation anesthesia; however, there was no significant between-group difference in 30-day postoperative mortality [22].…”

Total intravenous anesthesia decreases hospital stay but not incidence of postoperative pulmonary complications after lung resection surgery: a propensity score matching study

“…Intraoperative data, such as anesthesia regimens, anesthesia time were recorded. Postoperative events, such as PPCs (respiratory failure, respiratory infection, atelectasis, pneumothorax, bronchospasm, pleural effusion, upper airway obstruction, prolonged air leakage, pulmonary embolism,) [ 3 , 6 , 9 ], subcutaneous emphysema, chylothorax, re-operation, reintubation, LOS, 30-day unplanned readmission, and postoperative nausea and vomiting (PONV), were recorded as well. PONV was defined as any nausea or vomiting occurring during the first 24 to 48 h after the surgery [ 10 ].…”