Key result
Propofol anesthesia significantly decreased the incidence of new-onset postoperative atrial fibrillation compared to desflurane (0.8% vs 6.3%, OR 0.068) in patients undergoing video-assisted thoracoscopic surgery.
Why the study?
Postoperative atrial fibrillation increases postoperative morbidity, mortality, and hospital stay, and propofol modulates atrial electrophysiology and autonomic tone, but whether it suppresses POAF compared to desflurane in patients undergoing VATS was unknown.
Does continuous propofol administration reduce the incidence of new-onset postoperative atrial fibrillation compared to desflurane in adult patients undergoing video-assisted thoracoscopic surgery?
Cohort (n=482)
No
Does continuous propofol administration reduce the incidence of new-onset postoperative atrial fibrillation compared to desflurane in adult patients undergoing video-assisted thoracoscopic surgery?
Propofol anesthesia during video-assisted thoracoscopic surgery is associated with a significantly lower incidence of new-onset postoperative atrial fibrillation compared to desflurane.
Propofol was associated with lower POAF after VATS; hypothesis-generating and requires prospective confirmation before practice change.
BACKGROUND: Postoperative atrial fibrillation (POAF) increases postoperative morbidity, mortality, and length of hospital stay. Propofol is reported to modulate atrial electrophysiology and the cardiac autonomic nervous system. Therefore, we retrospectively examined whether propofol suppresses POAF in patients undergoing video-assisted thoracoscopic surgery (VATS) compared to desflurane. METHODS: We retrospectively recruited adult patients who underwent VATS during the period from January 2011 to May 2018 in an academic university hospital. Between continuous propofol and desflurane administration during anesthetic maintenance, we investigated the incidence of new-onset POAF (within 48 hours after surgery) before and after propensity score matching. RESULTS: Of the 482 patients, 344 received propofol, and 138 received desflurane during anesthetic maintenance. The incidence of POAF in the propofol group was less than that in the desflurane group (4 [1.2%] vs. 8 patients [5.8%], odds ratio [OR]; 0.161, 95% confidence interval (CI), 0.040-0.653, p = 0.011) in the present study population. After adjustment for propensity score matching (n = 254, n = 127 each group), the incidence of POAF was still less in propofol group than desflurane group (1 [0.8%] vs. 8 patients [6.3%], OR; 0.068, 95% CI: 0.007-0.626, p = 0.018). CONCLUSIONS: These retrospective data suggest propofol anesthesia significantly inhibits POAF compared to desflurane anesthesia in patients undergoing VATS. Further prospective studies are needed to elucidate the mechanism of propofol on the inhibition of POAF.
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Tajima et al. (2023) conducted a cohort in Lung disease requiring video-assisted thoracoscopic surgery (VATS) (n=482). Propofol anesthesia vs. Desflurane anesthesia was evaluated on Incidence of new-onset postoperative atrial fibrillation (POAF) within 48 hours after surgery (OR 0.068, 95% CI 0.007-0.626, p=0.018). Propofol anesthesia significantly decreased the incidence of new-onset postoperative atrial fibrillation compared to desflurane (0.8% vs 6.3%, OR 0.068) in patients undergoing video-assisted thoracoscopic surgery.
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