Desflurane improves lung collapse more than propofol during one-lung ventilation and reduces operation time in lobectomy by video-assisted thoracic surgery: a randomized controlled trial

Abstract

Background: This study evaluated whether desflurane improved lung collapse during one-lung ventilation (OLV) more than propofol, and whether it could reduce the operation time of video-assisted thoracic surgery.

Methods: Sixty patients undergoing lobectomy by video-assisted thoracic surgery (VATS) were randomly assigned to general anesthesia with desflurane or propofol. Lungs were inspected by thoracoscope at 10, 30, and 60 min after initiation of OLV. After surgery, the Lung Collapse Score, a composite of lung color and volume assessments, was assigned by two clinicians blinded to the anesthetic regimen. The primary outcome was operation time. The secondary outcome included the complication rate.

Results: Of the 60 participants, 50 completed the study, 26 in Desflurane group and 24 in Propofol group. The Lung Collapse Scores at 30 and 60 min after OLV initiation were significantly better in Desflurane group than in Propofol group, and operation time was significantly shorter in Desflurane group (214 (57) min vs. 262 (72) min [mean (SD)], difference in means, -48; 95% CI, -85 to -11; P = 0.01). The incidence of multiple complications was 1/26 (3%) and 6/24 (25%) in Desflurane and Propofol group, respectively (relative risk, 0.1; 95% CI, 0.02 to 1.18; P = 0.04).

Conclusions: Desflurane improved lung collapse during OLV and significantly shortened VATS lobectomy operation time compared to propofol in our studied patients. Desflurane resulted in fewer postoperative complications. Thus, desflurane may be an appropriate anesthetic during lobectomy by VATS requiring OLV.

Trial registration: The study was registered with the University Hospital Medical Information Network ( UMIN000009412 ). The date of disclosure of this study information is 27/11/2012. On this date, we registered the study into UMIN; patients were included from 2013 to 2014. However, on 11/27/2015, the UMIN system administrator suggested a detailed description. Thereafter, we added it to the Randomization Unit. Despite being prospective, it was retrospectively registered on UMIN for the above reasons.

Keywords: Desflurane; Lung collapse; One-lung ventilation; Propofol.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Assessment of Lung Collapse Score. The degree of lung collapse during one-lung ventilation was evaluated by measuring the Lung Collapse Score (Lung Collapse Score), evaluating the lung volume and the lung surface color. The upper panel shows a lung volume evaluation. In the distant view, with the video directed to the upper edge of the thoracic cavity, both the upper edge of the thoracic cavity and vertebral bodies are visible. The lung volume shown here is determined as 2. The lower panel shows a lung surface color evaluation. In this panel, as the white areas occupy between one-third and two-thirds of the lung surface, the color score is determined as 2

Fig. 2

Flow diagram of this study

Fig. 3

Five-year recurrence-free survival rate or overall survival rate after lobectomy under desflurane and propofol anesthesia. The recurrence-free survival rate and survival rates did not differ in these two groups (recurrence-free survival rate: P = 0.98, survival rate: P = 0.33)