Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?

Abstract

Background One-lung ventilation during thoracic surgery is associated with hypoxia–reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia–induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications. Methods Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age. Results Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71). Conclusions This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.

Short-Term Preoperative High-Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial

“…In a study involving mostly video-assisted thoracoscopic lung resections, Beck-Schimmer et al recently reported a 15% incidence of postoperative complications graded 3 to 4. 34 Besides the different threshold to capture postoperative morbidity, our study population was also at greater risk of postoperative complications given the more invasive surgical approach (an 81% rate of thoracotomies) and a higher proportion of extended resection (e.g., a 20% rate of pneumonectomy or bilobectomy). Although peakV : O 2 , peakWR, and walking distance were all increased after five to 10 HIIT sessions, this enhanced aerobic condition did not translate into better clinical outcome, except for a lower rate of atelectasis coupled with a shorter length of stay in the PACU.…”

Extrakorporale Membranoxygenierung in der Thoraxchirurgie: die Sicht des Anästhesisten

“…Bei der Wahl des Narkoseregimes gibt es bedingt durch eine supprimierte inflammatorische Reaktion auf eine ELV theoretische Vorteile für volatile Hypnotika [42]. Allerdings konnte hierdurch im Vergleich zu einer total intravenösen Anästhesie mit Propofol und Remifentanil keine Verbesserung der perioperativen Mortalität und Morbidität gezeigt werden [43,44].…”

Thirty Days Mortality Following Lung Resection: Risk Factors, Preoperative Assessment and Improvement Program

“…In summary, this RCT shows that desflurane does not reduce the major short-term and long-term complications of standard pulmonary surgery compared to propofol. 36 2.2) Ventilation management Thoracic surgery, whether it is lung surgery or surgery requiring one-lung ventilation (OLV), has one thing in common is that Anesthesiologists and surgeons compete for the same lung. The ventilation system may be damaged for a long time, which not only has multiple effects on breathing and hemodynamic physiology.…”