Key result
Inhaled anesthetics fail to reduce major postoperative complications vs IV anesthetics despite lowering pulmonary complications.
Why the study?
It is unclear whether inhaled or intravenous anesthetics are associated with different postoperative complications in patients undergoing one lung ventilation.
Do inhaled anesthetics reduce postoperative complications compared to intravenous anesthetics in patients undergoing one lung ventilation?
Meta-Analysis (n=2,522)
Do inhaled anesthetics reduce postoperative complications compared to intravenous anesthetics in patients undergoing one lung ventilation?
Inhaled anesthetics may reduce postoperative pulmonary complications compared to intravenous anesthetics in patients undergoing one lung ventilation, though other major complications and mortality are unaffected.
Introduction With the widely used technique of One Lung Ventilation (OLV) in patients throughout thoracic surgery, it’s unclear whether inhaled or intravenous anesthetics were associated with postoperative complications. The purpose of the current study is to compare the effects of intravenous and inhaled anesthetics on the postoperative complications within the patients suffering OLV. Methods We searched the related randomized controlled trials in PubMed and the Cochrane library up to 09\2021.Inclusive criteria were as follows: We included all the randomized controlled trials which compared the effects of intravenous and inhaled anesthetics on the postoperative complications[listed as: (a) major complications; (b)postoperative pulmonary complications (PPCs); (c) postoperative cognitive function (MMSE score); (d) length of hospital stay; (e) 30-days mortality] for the patients undergoing one lung ventilation. Results Thirteen randomized controlled trials with 2522 patients were included for analysis. Overall, there were no significant differences in the postoperative major complications between inhaled and intravenous anesthetics groups (OR 0.78, 95%CI 0.54 to 1.13, p =0.19; I 2 =0%). However, more PPCs were detected in intravenous groups when compared to inhaled groups (OR 0.62, 95%CI 0.44 to 0.87, p =0.005; I 2 =37%). Both the postoperative MMSE scores (SMD -1.94, 95%CI -4.87 to 0.99, p =0.19; I 2 =100%) and the length of hospital stay (SMD 0.05, 95%CI -0.29 to 0.39, p =0.76; I 2 =73%) were comparable between two groups. Besides, the 30-day mortality didn’t differ significantly across groups either (OR 0.79, 95%CI 0.03 to 18, p =0.88; I 2 =63%). Conclusions In patients undergoing OLV, generous anesthesia with inhaled anesthetics could reduce PPCs compared with intravenous anesthetics, but no evident advantages were provided over other major complications, cognitive function, hospital stay or mortality.
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Yang et al. (2022) conducted a meta-analysis in One Lung Ventilation (OLV) during thoracic surgery (n=2,522). Inhaled anesthetics (Sevoflurane or Desflurane) vs. Intravenous anesthetics (Propofol) was evaluated on Major postoperative complications assessed by Clavien-Dindo score (grade III to V) (OR 0.78, 95% CI 0.54 to 1.13, p=0.19). In patients undergoing one-lung ventilation, inhaled anesthetics did not significantly reduce major postoperative complications compared to intravenous anesthetics (OR 0.78, p=0.19), although they did reduce postoperative pulmonary complications.
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