Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Abstract

Background: One-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.

Methods: Adult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O. Arterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses included the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the serial changes in values.

Results: Patients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in desflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower in the desflurane group than the propofol group (170 ± 72 vs. 202 ± 82 mmHg; p = 0.039). Serial changes in PaO2 during one-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16-75 mmHg; p = 0.003).

Conclusions: In conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with that of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung cancer.

Trial registration: ClinicalTrials.gov identifier: NCT02191371 , registered on July 7, 2014.

Keywords: Desflurane; One-lung ventilation; Oxygenation; Propofol.

Figures

Fig. 1

CONSORT diagram of study flow

Fig. 2

Arterial oxygenation during desflurane-remifentanil vs. propofol-remifentanil anesthesia for one-lung ventilation. Data points are mean; error bars are SD. PaO2 during OLV was lower in the desflurane group than the propofol group. During desflurane anesthesia, PaO2 was significantly lower at 15, 30, and 45 min of OLV compared to the TLV state. PaO2, arterial partial pressure of oxygen; TLV, two-lung ventilation; OLV, one-lung ventilation; OLV15, 15 min of OLV; OLV30, 30 min of OLV; OLV45, 45 min of OLV; OLV60, 60 min of OLV. * p <0.01 between the two groups during OLV period (linear mixed model). # Adjusted p <0.01 when compared to the TLV state in the desflurane group (linear mixed model with Bonferroni’s correction)