Effect Of Sevoflurane And Propofol On Postoperative Pulmonary Complications During Hospitalization In Patients Undergoing Thoracoscopic Pneumonectomy

BACKGROUND:It is reported that lung cancer is one of the most widely seen cancer currently in China.Lung resection surgery is an important treatment method for lung cancer,however,postoperative pulmonary complications(PPCs)occurred frequently,after thoracoscopic pneumonectomy,which affect the recovery of patients,reduced their satisfaction and increased their corresponding medical economic burden.Therefore,it is worth to study how to reduce the incidence of postoperative pulmonary complications in patients undergoing thoracoscopic pneumonectomy.The combination of postoperative adverse pulmonary outcomes is known as postoperative pulmonary complications.Postoperative pulmonary complications include atelectasis,respiratory failure,respiratory tract infection,bronchospasm,pleural effusion,pneumothorax,aspiration pneumonia,etc.There are many factors that can cause PPCs,which summarized as three aspects: patient’s factors(chronic obstructive pulmonary disease,recently has a history of acute respiratory infections,corticosteroid use,etc.),operation factors(operation methods,operation time,intraoperative massive blood transfusion,etc.),and anesthesia factors(narcotic drugs,ventilation mode,quantity and type of intraoperative liquid).Previous studies have shown that local and systemic inflammatory responses induced by anesthesia and surgery are important reasons for postoperative pulmonary complications.Severe perioperative inflammatory reactions were observed in Lung Resection Surgery(LRS),which are related to airway injury on the ventilation side,lung collapse on the non-ventilation side and surgical operation during one-lung ventilation.The choice of anesthetic agents may influence the perioperative inflammatory response.Sevoflurane and propofol are two of the most widely used general anesthesia drugs in clinical practice.Sevoflurane is a new inhalation anesthetics with rapid induction and low blood gas distribution coefficient,which makes it easier to control anesthesia depth,predict recovery time and maintain hemodynamic stability.Compared with other inhalation anesthetics agents,sevoflurane characterized as rapid induction,stable maintenance,rapid and complete recovery,and certain protective effect on myocardial ischemia and reperfusion injury,so it is playing more and more important roles in clinical anesthesia.Propofol is a new,rapid intravenous anesthetic that reduces cortisol and catecholamines and inhibits adrenocortical hormone secretion,with rapid return to preoperative levels upon withdrawal.Sevoflurane and propofol are commonly used in anesthetics,which both of them have effects on perioperative inflammatory response.However,the effects of them on postoperative pulmonary complications are still controversial.OBJECTIVE:To compare the effects of sevoflurane and propofol on the incidence of postoperative pulmonary complications in patients undergoing thoracoscopic pneumonectomy during hospitalization,and to provide a reasonable anesthesia plan for the implementation of thoracoscopic pneumonectomy.METHODS:Two hundred patients underwent elective LRS,aged 45-65,no limit on the gender;Patients(propofol group or sevoflurane group)were randomly divided into two groups using the same anesthesia induction regimen by random number table method(Midazolam(0.03-0.05 mg/kg),sufentanil(0.3-0.5μg/kg),etomidate(0.1-0.4 mg/kg),rocuronium(0.6-1.0 mg/kg).Anesthesia maintenance was performed with sevoflurane combined with remifentanil in the sevoflurane group and propofol combined with remifentanil in the propofol group.The incidence of postoperative pulmonary complications,length of stay and days of drainage tube indwelling were collected by the professional stuff who were not informed of the grouping.The Visual analogue scale(VAS)was used for pain scoring,the resting pain score and coughing pain score were recorded 24 h after surgery.Venous blood 5ml was taken from the central vein 5 minutes before induction of anesthesia and the end of surgery.The concentrations of interleukin 6(IL-6),interleukin 1β(IL-1β),monocyte chemotactic protein(MCP),neutrophil elastase(NE),malondialdehyde(MDA)and superoxide dismutase(SOD)in plasma were determined by the same specialist.RESULTS:Primary results: There was no significant difference in the overall incidence of postoperative pulmonary complications between the sevoflurane group and the propofol group(p = 0.435);The incidence of pleural effusion was lower in the sevoflurane group than in the propofol group(p = 0.012).Secondary results: Postoperative hospital stay days [7(5-8)vs 6(5-8),p = 0.457],drainage tube indwelling time [3(3-4)vs 3(3-5),p = 0.159],postoperative resting pain score [1(0-2)vs 1(0-2),p = 0.626] and postoperative coughing pain score [2(0-3)vs 2(0.75-3),p = 0.548] were not statistically significant.There were no significant differences in plasma IL-6,IL-1β,MCP,NE between the two groups.There were no significant differences in plasma MDA concentration and SOD activity between the two groups.CONCLUSION:There was no difference in the effect of sevoflurane and propofol on the incidence of overall postoperative pulmonary complications in patients undergoing thoracoscopic pneumonectomy during hospitalization.Compared with propofol,sevoflurane can reduce the incidence of postoperative pleural effusion.There was no difference in the effects of sevoflurane and propofol on systemic inflammatory response and oxidative stress at the end of surgery in patients undergoing thoracoscopic pneumonectomy.