Inhalational versus intravenous anesthetics during one lung ventilation in elective thoracic surgeries: A narrative review

Abstract

The anesthesia regimen used during one lung ventilation (OLV) carry the potential to affect intra-operative course and post-operative outcomes, by its effects on pulmonary vasculature and alveolar inflammation. This narrative review aims to understand the pathophysiology of acute lung injury during one lung ventilation, and to study the effects of inhalational versus intravenous anaesthetics on intraoperative and post-operative outcomes, following thoracic surgery. For this purpose, we independently searched 'PubMed', 'Google Scholar' and 'Cochrane Central' databases to find out randomized controlled trials (RCTs), in English language, which compared the effects of intravenous versus inhalational anaesthetics on intraoperative and post-operative outcomes, in elective thoracic surgeries, in human beings. In total, 38 RCTs were included in this review. Salient results of the review are- Propofol reduced intraoperative shunt and maintained better intraoperative oxygenation than inhalational agents. However, use of modern inhalational anaesthetics during OLV reduced alveolar inflammation significantly, as compared to propofol. Regarding post-operative complications, the evidence is not conclusive enough but slightly in favour of inhalational anaesthetics. Thus, we conclude that modern inhalational anaesthetics, by their virtue of better anti-inflammatory properties, exhibit lung protective effects and hence, seem to be safe for maintenance of anesthesia during OLV in elective thoracic surgeries. Further research is required to establish the safety of these agents with respect to long term post-operative outcomes like cancer recurrence.

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

“…During lung cancer surgery, major physiological changes, including respiratory stress and activation of inflammation and immune response, can occur due to one-lung ventilation and the surgical stimulation [4]. Therefore, anesthetics may affect the outcome of lung cancer surgery.…”

“…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.…”

“…However, surgery can cause local tissue damage, which activates the neuroendocrine and immune systems, and micrometastasis through the spread of cancer cells into the systemic circulation [1,2]. As well as surgery, anesthetics also play a crucial role in this pathophysiology [3][4][5]. Anesthetic agents can affect immunomodulation, metabolic pathways, and cancer progression through various mechanisms; therefore, they may be associated with long-term oncological prognosis [3,6,7].…”

“…However, it remarkably decreases when cancer metastasizes to local lymph nodes (33.5%) or distant metastases (7%) [17]. Curative resection for lung cancer is one of the major lengthy surgeries; furthermore, all patients should undergo onelung ventilation, which can induce physiological and pathological alterations [4]. However, the effects of anesthetics on lung cancer prognosis remain unclear.…”

Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review

“…On the other hand, it seems that propofol reduces the intraoperative shunt and maintains better oxygenation during OLV as compared to VA [ 103 ]. In contrast, TIVA did not better preserve V/Q matching in patients with normal lungs undergoing anaesthesia with controlled ventilation compared with sevoflurane [ 104 ].…”