The Effects of Sevoflurane vs. Propofol for Inflammatory Responses in Patients Undergoing Lung Resection: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: Inflammatory cytokines are increased during one-lung ventilation in patients undergoing lung resection, and this increase can be fatal. Propofol and sevoflurane are the main anesthetics used for these patients. Unfortunately, there is no consensus on the best choice of an anesthetic agent concerning an inflammatory response in patients undergoing lung resection. This meta-analysis aimed to compare the effects of propofol and sevoflurane on the inflammatory response in patients undergoing lung resection.Methods: We searched electronic databases to identify randomized controlled trials comparing the effects of different anesthetics (sevoflurane vs. propofol) on the inflammatory response. The primary outcome concerned the concentration of systemic inflammatory cytokines. The secondary outcomes concerned the concentrations of inflammatory cytokines in the bronchoalveolar lavage (BAL) fluid from the dependent and independent lung. Random effects analysis of the meta-analyses were performed to synthesize the evidence and to assess the concentrations of inflammatory factors in the sevoflurane and propofol groups.Results: Eight trials involving 488 participants undergoing lung resection with one-lung ventilation were included. There was no significant difference in the concentrations of systemic interleukin (IL)-6, IL-10, or tumor necrosis factor α between the sevoflurane and propofol groups. Compared with the propofol group, BAL levels of IL-6 in the dependent ventilated lung were decreased in the sevoflurane group (three trials, 256 participants; standardized mean difference [SMD], −0.51; 95% confidence interval [CI], −0.90 to −0.11; p = 0.01; I2 = 46%). The BAL levels of IL-6 in the independent ventilated lung were also decreased by sevoflurane (four trials, 362 participants; SMD, −0.70; 95% [CI], −0.93 to −0.47; p < 0.00001; I2 = 0%).Conclusions: There was no difference in the systemic inflammatory response between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can reduce the local alveolar inflammatory response. Additional research is necessary to confirm whether the inflammatory response is direct or indirect.

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

“…In case of the clinical surgery proceeded with OLV, inhaled anesthetics were found to play anti-inflammatory role by acting on the cytokine responses, ischaemia-reperfusion and oxidative stress(15, 34). Besides, meta-analysis concluded that compared with total intravenous anesthesia, total inhaled anesthesia could reduce the alveolar inflammatory responses but had no significantly effect on the systematic inflammatory responses in the meantime(10), which may contribute to the results that inhaled agents have a benefit effect on the incidence of PPCs rather than the other systematically complications.…”

“…However, Bassi.A (7) and Modolo.NS (3) revealed that few evidence from randomized controlled trials(RCTs) demonstrated significant difference in particular postoperative outcomes between general anesthesia maintained by inhaled and intravenous anesthetics in case of OLV in 2008 and 2013. Later, several RCTs and systematic reviews suggested that inhalation might preserve intraoperative cardiac function, reduce PPCs, attenuate local alveolar inflammatory responses in patients undergoing OLV (8)(9)(10).…”

The effect of low flow anesthesia with sevoflurane on oxidative status

“…In another research, the efficacy of propofol and sevoflurane on the systemic and local inflammatory response during single lung ventilation in patients who underwent lung resection were compared, and it was shown that sevoflurane could not reduce the systemic inflammatory response, but reduced the local alveolar inflammatory response. 23 Previous animal experiments have shown that sevoflurane was associated with physiological processes such as reducing free oxygen radicals, reducing inflammation by lowering the intracellular calcium level, and improving energy metabolism. 24 , 25 In recent studies, sevoflurane has been shown to increase the level of ROS and pro-inflammatory cytokines in metabolism, thereby triggering the NF-κB signaling pathway.…”

Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review

“…Inhalants seem to attenuate the local pulmonary inflammatory response more than propofol, while propofol provides greater protection against the systemic inflammatory response. A meta-analysis of 8 studies involving 488 patients undergoing lung resection with one-lung ventilation (OLV), found no significant differences in the concentrations of systemic IL-6, IL-10 and TNF-α between sevoflurane and propofol ( 102 ). However, in the same meta-analysis, IL-6 levels in the BAL fluid in both the dependent and independent lung were decreased with sevoflurane compared to propofol ( 102 ).…”

“…A meta-analysis of 8 studies involving 488 patients undergoing lung resection with one-lung ventilation (OLV), found no significant differences in the concentrations of systemic IL-6, IL-10 and TNF-α between sevoflurane and propofol ( 102 ). However, in the same meta-analysis, IL-6 levels in the BAL fluid in both the dependent and independent lung were decreased with sevoflurane compared to propofol ( 102 ). A prospective study reported decreased number of T lymphocytes and NK cells after surgery in NSCLC patients, but the decrease was lesser in patients who received combined sevoflurane-epidural anesthesia compared to those who received total intravenous anesthesia ( 103 ).…”