The Effects of Sevoflurane vs. Propofol for Inflammatory Responses in Patients Undergoing Lung Resection: A Meta-Analysis of Randomized Controlled Trials

Jing-Li Yuan, Kang Kang, Bing Li, Jie Lu, Meng-Rong Miao, Xia Kang, Jia-Qiang Zhang, Wei Zhang, Jing-Li Yuan, Kang Kang, Bing Li, Jie Lu, Meng-Rong Miao, Xia Kang, Jia-Qiang Zhang, Wei Zhang

Abstract

Objective: Inflammatory cytokines are increased during one-lung ventilation in patients undergoing lung resection, and this increase can be fatal. Propofol and sevoflurane are the main anesthetics used for these patients. Unfortunately, there is no consensus on the best choice of an anesthetic agent concerning an inflammatory response in patients undergoing lung resection. This meta-analysis aimed to compare the effects of propofol and sevoflurane on the inflammatory response in patients undergoing lung resection. Methods: We searched electronic databases to identify randomized controlled trials comparing the effects of different anesthetics (sevoflurane vs. propofol) on the inflammatory response. The primary outcome concerned the concentration of systemic inflammatory cytokines. The secondary outcomes concerned the concentrations of inflammatory cytokines in the bronchoalveolar lavage (BAL) fluid from the dependent and independent lung. Random effects analysis of the meta-analyses were performed to synthesize the evidence and to assess the concentrations of inflammatory factors in the sevoflurane and propofol groups. Results: Eight trials involving 488 participants undergoing lung resection with one-lung ventilation were included. There was no significant difference in the concentrations of systemic interleukin (IL)-6, IL-10, or tumor necrosis factor α between the sevoflurane and propofol groups. Compared with the propofol group, BAL levels of IL-6 in the dependent ventilated lung were decreased in the sevoflurane group (three trials, 256 participants; standardized mean difference [SMD], -0.51; 95% confidence interval [CI], -0.90 to -0.11; p = 0.01; I 2 = 46%). The BAL levels of IL-6 in the independent ventilated lung were also decreased by sevoflurane (four trials, 362 participants; SMD, -0.70; 95% [CI], -0.93 to -0.47; p < 0.00001; I 2 = 0%). Conclusions: There was no difference in the systemic inflammatory response between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can reduce the local alveolar inflammatory response. Additional research is necessary to confirm whether the inflammatory response is direct or indirect.

Keywords: OLV; inflammatory response; meta-analysis; propofol; sevoflurane.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Yuan, Kang, Li, Lu, Miao, Kang, Zhang and Zhang.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Forest plot for the concentrations of systemic interleukin-6.
Figure 4
Figure 4
Forest plot for the concentrations of systemic interleukin-10.
Figure 5
Figure 5
Forest plot for the concentrations of systemic tumor necrosis factor α.
Figure 6
Figure 6
Forest plot for the concentration of dependent alveolar interleukin-6.
Figure 7
Figure 7
Forest plot for the concentration of dependent alveolar interleukin-8.
Figure 8
Figure 8
Forest plot for the concentration of independent alveolar interleukin-6.
Figure 9
Figure 9
Forest plot for the concentration of independent alveolar interleukin-8.
Figure 10
Figure 10
Forest plot for the concentration of independent alveolar tumor necrosis factor α.

References

    1. Okamoto K, Hayashi K, Kaku R, Kawaguchi Y, Oshio Y, Hanaoka J. Impact of fractional exhaled nitric oxide on the outcomes of lung resection surgery: a prospective study. J Thorac Dis. (2020) 12:2663–71. 10.21037/jtd.2020.03.18
    1. Schilling T, Kozian A, Huth C, Bühling F, Kretzschmar M, Welte T, et al. . The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg. (2005) 101:957–65. 10.1213/01.ane.0000172112.02902.77
    1. Schilling T, Kozian A, Senturk M, Huth C, Reinhold A, Hedenstierna G, et al. . Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients. Anesthesiology. (2011) 115:65–74. 10.1097/ALN.0b013e318214b9de
    1. Cantor H, Boyse EA. Functional subclasses of T lymphocytes bearing different Ly antigens. II Cooperation between subclasses of Ly+ cells in the generation of killer activity. J Exp Med. (1975) 141:1390–9. 10.1084/jem.141.6.1390
    1. Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin. (2008) 26:241–72. 10.1016/j.anclin.2008.01.011
    1. Tekinbas C, Ulusoy H, Yulug E, Erol MM, Alver A, Yenilmez E, et al. . One-lung ventilation: for how long? J Thorac Cardiovasc Surg. (2007) 134:405–10. 10.1016/j.jtcvs.2007.05.003
    1. De Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. . Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. (2009) 110:1316–26. 10.1097/ALN.0b013e3181a10731
    1. Lee JJ, Kim GH, Kim JA, Yang M, Ahn HJ, Sim WS, et al. . Comparison of pulmonary morbidity using sevoflurane or propofol-remifentanil anesthesia in an Ivor Lewis operation. J Cardiothorac Vasc Anesth. (2012) 26:857–62. 10.1053/j.jvca.2012.01.015
    1. Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. (2001) 20:455–63. 10.1016/S1010-7940(01)00841-7
    1. Sugasawa Y, Yamaguchi K, Kumakura S, Murakami T, Kugimiya T, Suzuki K, et al. . The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection. J Anesth. (2011) 25:170–7. 10.1007/s00540-011-1100-0
    1. Broccard AF, Hotchkiss JR, Suzuki S, Olson D, Marini JJ. Effects of mean airway pressure and tidal excursion on lung injury induced by mechanical ventilation in an isolated perfused rabbit lung model. Crit Care Med. (1999) 27:1533–41. 10.1097/00003246-199908000-00022
    1. Slutsky AS. Lung injury caused by mechanical ventilation. Chest. (1999) 116(1 Suppl):9S−15S. 10.1378/chest.116.suppl_1.9S-a
    1. Baudouin SV. Lung injury after thoracotomy. Br J Anaesth. (2003) 91:132–42. 10.1093/bja/aeg083
    1. de la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L, Cruz P, et al. . Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth. (2017) 119:655–63. 10.1093/bja/aex230
    1. Jin Y, Zhao X, Li H, Wang Z, Wang D. Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one-lung ventilation. Exp Ther Med. (2013) 6:781–5. 10.3892/etm.2013.1194
    1. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. . Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. (2019) 10:ED000142. 10.1002/14651858.ED000142
    1. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. (2009) 6:e1000097. 10.1371/journal.pmed.1000097
    1. McGrath S, Zhao X, Steele R, Thombs BD, Benedetti A; DEPRESsion Screening Data (DEPRESSD) Collaboration. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res. (2020) 962280219889080. 10.1177/0962280219889080
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. . The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. (2011) 343:d5928. 10.1136/bmj.d5928
    1. Houston M. Ireland leads the way for Europe in banning smoking in the workplace. BMJ. (2003) 327:522. 10.1136/bmj.327.7414.522
    1. Sugasawa Y, Yamaguchi K, Kumakura S, Murakami T, Suzuki K, Nagaoka I, et al. . Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection. J Anesth. (2012) 26:62–9. 10.1007/s00540-011-1244-y
    1. Hammouda SA, Abd Rabbih AA, Alganady AA, Ghoneim TA, Elsawy MM, Youssif SA. Immunomodulatory effect of propofol versus sevoflurane in patients undergoing thoracic surgery using one lung ventilation technique. Egypt J Chest Dis Tuberc. (2013) 62:731–43. 10.1016/j.ejcdt.2013.08.005
    1. Tian HT, Duan XH, Yang YF, Wang Y, Bai QL, Zhang X. Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response, pulmonary function and cognitive function in patients receiving lung cancer resection. Eur Rev Med Pharmacol Sci. (2017) 21:5515–22. 10.26355/eurrev_201712_13943
    1. Potočnik I, Novak Janković V, Šostarič M, Jerin A, Štupnik T, Skitek M, et al. . Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation. Croat Med J. (2014) 55:628–37. 10.3325/cmj.2014.55.628
    1. Tsai JA, Lund M, Lundell L, Nilsson-Ekdahl K. One-lung ventilation during thoracoabdominal esophagectomy elicits complement activation. J Surg Res. (2009) 152:331–7. 10.1016/j.jss.2008.03.046
    1. Langlois-Karaga A, Bues-Charbit M, Balansard G, Charpin D, Vervloet D, Sutra JP, et al. . Variations spatiales et temporelles des quantités de pollen de Cupressacées-Taxacées recueillies à Marseille [Spatial and temporal variations of the quantities of pollen from Cupressaceae-Taxaceae collected in Marseilles]. Allerg Immunol. (1992) 24:213–15.
    1. Sun B, Wang J, Bo L, Zang Y, Gu H, Li J, et al. . Effects of volatile vs. propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilation: a meta-analysis of randomized controlled trials. J Anesth. (2015) 29:570–9. 10.1007/s00540-015-1987-y
    1. Fortis S, Spieth PM, Lu WY, Parotto M, Haitsma JJ, Slutsky AS, et al. . Effects of anesthetic regimes on inflammatory responses in a rat model of acute lung injury. Intensive Care Med. (2012) 38:1548–55. 10.1007/s00134-012-2610-4
    1. Suter D, Spahn DR, Blumenthal S, Reyes L, Booy C, Z'graggen BR, et al. . The immunomodulatory effect of sevoflurane in endotoxin-injured alveolar epithelial cells. Anesth Analg. (2007) 104:638–45. 10.1213/01.ane.0000255046.06058.58
    1. Torres MF, Porfírio GJ, Carvalho AP, Riera R. Non-invasive positive pressure ventilation for prevention of complications after pulmonary resection in lung cancer patients. Cochrane Database Syst Rev. (2019) 3:CD010355. 10.1002/14651858.CD010355.pub3
    1. Ng CS, Lau KK. Surgical trauma and immune functional changes following major lung resection. Indian J Surg. (2015) 77:49–54. 10.1007/s12262-013-0957-6

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa