For one-lung ventilation during thoracic surgery, is it better to use desflurane or sevoflurane rather than propofol?
When patients undergo lung resection, one-lung ventilation is frequently used. Inflammatory mediators are released during one-lung ventilation. All things being equal, does the type of anesthesia that is used affect this response? In their study titled “Effects of Volatile and Intravenous Anesthesia on the Alveolar and Systemic Inflammatory Response in Thoracic Surgical Patients,” the authors randomized 63 patients who underwent open lung surgery with one-lung ventilation to receive propofol, desflurane, or sevoflurane anesthesia. They took great care to make sure other aspects of anesthetic management were equivalent: intraoperatively, a remifentanil infusion was used and patients were ventilated using pressure-controlled mechanical ventilation with a tidal volume of approximately 7 ml Â· kg âˆ’1 ideal body weight, peak airway pressure lower than 30 cm H2O, a respiratory rate adjusted to a PaCO2 of 40 mmHg, and a fraction of inspired oxygen lower than 0.8 during one-lung ventilation.
Release of proinflammatory cytokines increased after one-lung ventilation, though they were less when desflurane or sevoflurane was used. Specifically, tumor necrosis factor-Î±, interleukin-8, and interleukin-1Î² release were all greater after propofol anesthesia compared to either desflurane or sevoflurane administration.
In models of acute respiratory distress syndrome, mortality is less when tidal volumes are reduced. Moreover, plasma interleukin (IL)-6 concentrations are lower in patients ventilated with a low VT.(1) Whether the difference in plasma interleukin (IL)-6 concentrations is the reason why mortality is less is not clear. Similarly in this study, whether the changes in release of proinflammatory substances into the alveoli of the ventilated lung are also associated with differences in postoperative outcome is unclear. Postoperative outcome was not studied in this report. Though the results are interesting, more study is needed.
1. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301â€“1308