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Zhang Y, Zha T, Song G, Abudurousuli G, Che J, Zhao F, Zhang L, Zhang X, Gui B, Zhu L. Unveiling the protective role of sevoflurane in video-assisted thoracoscopic surgery associated-acute lung injury: Inhibition of ferroptosis. Pulm Pharmacol Ther 2024; 86:102312. [PMID: 38906321 DOI: 10.1016/j.pupt.2024.102312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 06/23/2024]
Abstract
Acute lung injury (ALI) frequently occurs after video-assisted thoracoscopic surgery (VATS). Ferroptosis is implicated in several lung diseases. Therefore, the disparate effects and underlying mechanisms of the two commonly used anesthetics (sevoflurane (Sev) and propofol) on VATS-induced ALI need to be clarified. In the present study, enrolled patients were randomly allocated to receive Sev (group S) or propofol anesthesia (group P). Intraoperative oxygenation, morphology of the lung tissue, expression of ZO-1, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), superoxide dismutase (SOD), glutathione (GSH), Fe2+, glutathione peroxidase 4 (GPX4), and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/nuclear factor erythroid-2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway in the lung tissue as well as the expression of TNF-α and IL-6 in plasma were measured. Postoperative complications were recorded. Of the 85 initially screened patients scheduled for VATS, 62 were enrolled in either group S (n = 32) or P (n = 30). Compared with propofol, Sev substantially (1) improved intraoperative oxygenation; (2) relieved histopathological lung injury; (3) increased ZO-1 protein expression; (4) decreased the levels of TNF-α and IL-6 in both the lung tissue and plasma; (5) increased the contents of GSH and SOD but decreased Fe2+ concentration; (6) upregulated the protein expression of p-AKT, Nrf2, HO-1, and GPX4. No significant differences in the occurrence of postoperative outcomes were observed between both groups. In summary, Sev treatment, in comparison to propofol anesthesia, may suppress local lung and systemic inflammatory responses by activating the PI3K/Akt/Nrf2/HO-1 pathway and inhibiting ferroptosis. This cascade of effects contributes to the maintenance of pulmonary epithelial barrier permeability, alleviation of pulmonary injury, and enhancement of intraoperative oxygenation in patients undergoing VATS.
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Affiliation(s)
- Yang Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tianming Zha
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Guoxin Song
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Gulibositan Abudurousuli
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jinxin Che
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China; Department of Anesthesiology, The Huai'an Maternity and Child Healthcare Hospital, Huai'an, China
| | - Fei Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xing Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
| | - Linjia Zhu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Miao H, Ge D, Wang Q, Zhou L, Chen H, Qin Y, Zhang F. Predictive significance of systemic immune-inflammation index combined with prealbumin for postoperative pneumonia following lung resection surgery. BMC Pulm Med 2024; 24:277. [PMID: 38862955 PMCID: PMC11167804 DOI: 10.1186/s12890-024-03086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND We aimed to determine whether systemic immune-inflammation index (SII) combined with prealbumin can provide better predictive power for postoperative pneumonia in patients undergoing lung resection surgery. METHODS We identified eligible patients undergoing lung resection surgery at the Affiliated Hospital of Nantong University from March 2021 to March 2022. Demographic characteristics, clinical data, and laboratory information were collected and reviewed from the electronic medical records of the patients. To test the effect of the combined detection of SII and prealbumin, we made an equation using logistic regression analysis. The receiver operating characteristic curve (ROC) was plotted to evaluate the predictive powers, sensitivity, and specificity of prealbumin, SII, and SII combined with prealbumin. Decision curve analysis (DCA) was used to determine the clinical validity and net benefit of different methods of detection. RESULTS Totally 386 eligible patients were included with a median age of 62.0 years (IQR: 55.0, 68.0), and 57 (14.8%) patients presented with postoperative pneumonia within 7 days after surgery. The multivariate regression analysis showed that preoperative SII as continuous variable was associated with an increased risk of postoperative pneumonia (OR: 1.38, 95% CI: 1.19-2.83, P = 0.011), whereas the prealbumin as continuous variable remained as an independent protective predictor of postoperative pneumonia in the adjusted analysis (OR: 0.80, 95% CI: 0.37-0.89, P = 0.023). Compared to SII or prealbumin, the combined detection of preoperative SII and prealbumin showed a higher predictive power with area under curve of 0.79 (95% CI: 0.71-0.86, P < 0.05 for all). Additionally, DCA indicated that the combined detection was superior over preoperative SII or prealbumin alone in clinical validity and net benefit. CONCLUSION Both preoperative SII and prealbumin are independent influencing factors for postoperative pneumonia after lung resection surgery. The combined detection of preoperative SII and prealbumin can significantly improve prediction capability to identify potential postoperative pneumonia-susceptible patients, facilitating early interventions to improve postoperative quality of life for surgical lung resection patients.
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Affiliation(s)
- Haihang Miao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Dingying Ge
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Qianwen Wang
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Lulu Zhou
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Hongsheng Chen
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
| | - Yibin Qin
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
| | - Faqiang Zhang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
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Liu HM, Zhang GW, Yu H, Li XF, Yu H. Association between mechanical power during one-lung ventilation and pulmonary complications after thoracoscopic lung resection surgery: a prospective observational study. BMC Anesthesiol 2024; 24:176. [PMID: 38760677 PMCID: PMC11100229 DOI: 10.1186/s12871-024-02562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The role of mechanical power on pulmonary outcomes after thoracic surgery with one-lung ventilation was unclear. We investigated the association between mechanical power and postoperative pulmonary complications in patients undergoing thoracoscopic lung resection surgery. METHODS In this single-center, prospective observational study, 622 patients scheduled for thoracoscopic lung resection surgery were included. Volume control mode with lung protective ventilation strategies were implemented in all participants. The primary endpoint was a composite of postoperative pulmonary complications during hospital stay. Multivariable logistic regression models were used to evaluate the association between mechanical power and outcomes. RESULTS The incidence of pulmonary complications after surgery during hospital stay was 24.6% (150 of 609 patients). The multivariable analysis showed that there was no link between mechanical power and postoperative pulmonary complications. CONCLUSIONS In patients undergoing thoracoscopic lung resection with standardized lung-protective ventilation, no association was found between mechanical power and postoperative pulmonary complications. TRIAL REGISTRATION Trial registration number: ChiCTR2200058528, date of registration: April 10, 2022.
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Affiliation(s)
- Hong-Mei Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
- West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Gong-Wei Zhang
- Department of Anesthesiology, West China (Airport) Hospital, Sichuan University, Chengdu, 610072, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xue-Fei Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Zhu J, Wei B, Wu L, Li H, Zhang Y, Lu J, Su S, Xi C, Liu W, Wang G. Thoracic paravertebral block for perioperative lung preservation during VATS pulmonary surgery: study protocol of a randomized clinical trial. Trials 2024; 25:74. [PMID: 38254233 PMCID: PMC10801977 DOI: 10.1186/s13063-023-07826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) extend the length of stay of patients and increase the perioperative mortality rate after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS surgery; however, little is known about the effect of TPVB on the incidence of PPCs. The aim of this study is to determine whether TPVB combined with GA causes fewer PPCs and provides better perioperative lung protection in patients undergoing VATS pulmonary surgery than simple general anaesthesia. METHODS A total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: the paravertebral block group (PV group) and the control group (C group). Patients in the PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces before general anaesthesia induction. Patients in the C group will not undergo the intervention. Both groups of patients will be subjected to a protective ventilation strategy during the operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient-controlled intravenous analgesia is used for postoperative analgesia. The primary endpoint is a composite outcome of PPCs within 7 days after surgery. Secondary endpoints include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization-related indicators and long-term prognosis indicators. DISCUSSION This study will better evaluate the impact of TPVB on the incidence of PPCs and the long-term prognosis in patients undergoing VATS lobectomy/segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05922449 . Registered on June 25, 2023.
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Affiliation(s)
- Jiayu Zhu
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Biyu Wei
- Department of Anaesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101100, China
| | - Lili Wu
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - He Li
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yi Zhang
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jinfeng Lu
- Department of Anaesthesiology, Beijing Renhe Hospital, Beijing, 102600, China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Chaoyang, Beijing, 100026, China
| | - Chunhua Xi
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Liu
- Department of Anaesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101100, China.
| | - Guyan Wang
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Zhang YT, Chen Y, Shang KX, Yu H, Li XF, Yu H. Effect of Volatile Anesthesia Versus Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Clinical Trial. Anesth Analg 2024:00000539-990000000-00702. [PMID: 38195081 DOI: 10.1213/ane.0000000000006814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The effect of intraoperative anesthetic regimen on pulmonary outcome after minimally invasive esophagectomy for esophageal cancer is yet undetermined. The aim of this study was to determine the effect of volatile anesthesia (sevoflurane or desflurane) compared with propofol-based intravenous anesthesia on pulmonary complications after minimally invasive esophagectomy. METHODS Patients scheduled for minimally invasive esophagectomy were randomly assigned to 1 of 3 general anesthetic regimens (sevoflurane, desflurane, or propofol). The primary outcome was the incidence of pulmonary complications within the 7 days postoperatively, which was a collapsed composite end point, including respiratory infection, pleural effusion, pneumothorax, atelectasis, respiratory failure, bronchospasm, pulmonary embolism, and aspiration pneumonitis. The severity of pulmonary complications, surgery-related complications, and other secondary outcomes were also assessed. RESULTS Of 647 patients assessed for eligibility, 558 were randomized, and 553 were analyzed. A total of 185 patients were assigned to the sevoflurane group, 185 in the desflurane, and 183 in the propofol group. Patients receiving a volatile anesthetic (sevoflurane or desflurane) had a significantly lower incidence (36.5% vs 47.5%; odds ratio, 0.63; 95% confidence interval, 0.44-0.91; P = .013) and lower severity grade of pulmonary complications (P = .035) compared to the patients receiving propofol. There were no statistically significant differences in other secondary outcomes between the 2 groups. CONCLUSIONS In patients undergoing minimally invasive esophagectomy, the use of volatile anesthesia (sevoflurane or desflurane) resulted in the reduced risk and severity of pulmonary complications within the first 7 postoperative days as compared to propofol-based intravenous anesthesia.
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Affiliation(s)
- Yu-Tong Zhang
- From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Chen
- Department of Anesthesiology, Hospital of Integrated Traditional Chinese and Western Medicine of Liangshan Prefecture, Xichang, China
| | - Kai-Xi Shang
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Hong Yu
- From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue-Fei Li
- From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yu
- From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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Alfaras-Melainis K, Fernando RJ, Boisen ML, Hoffman PJ, Rosenkrans DJ, Teeter E, Cardi AI, Laney J, Reagan A, Rao VK, Anderson M, Luke CB, Subramani S, Schisler T, Ritchie PJ, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2024; 38:29-56. [PMID: 37802689 DOI: 10.1053/j.jvca.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
This article reviews research highlights in the field of thoracic anesthesia. The highlights of this year included new developments in the preoperative assessment and prehabilitation of patients requiring thoracic surgery, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic and postoperative management of these patients, including protective OLV ventilation, the use of opioid-sparing techniques and regional anesthesia, and outcomes using enhanced recovery after surgery, as well as the use of expanding indications for extracorporeal membrane oxygenation, specialized anesthetic techniques for airway surgery, and nonintubated video-assisted thoracic surgery.
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Affiliation(s)
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Paul J Hoffman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Alessandra I Cardi
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Jeremy Laney
- Department of Anesthesiology, University of Southern California, Los Angeles, CA
| | - Aaron Reagan
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Michael Anderson
- Department of Anesthesiology and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Charles B Luke
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Zhang YY, Zhang YM, Wu SL, Wei M, Deng ZP, Lei XY, Bai YP, Wang XB. Association of mechanical power during one-lung ventilation and post-operative pulmonary complications among patients undergoing lobectomy: a protocol for a prospective cohort study. Updates Surg 2023; 75:2365-2375. [PMID: 37540406 DOI: 10.1007/s13304-023-01595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/27/2023] [Indexed: 08/05/2023]
Abstract
The association of intra-operative mechanical power (MP) with post-operative pulmonary complications (PPCs) has been described before, but it is uncertain whether the potential inherent bias can limit the use of this parameter, particularly in the context of one-lung ventilation. This single-center study aims to investigate the effect of MP during one-lung ventilation (OLV), and the risks of PPCs in patients undergoing thoracoscopic lobectomy. This prospective observational study is being conducted in an academic tertiary hospital in mainland China. Participants diagnosed with lung cancer, and aged 50 to 80 years are eligible. Video-assisted thoracoscopic surgery (VATS) lobectomy is performed for all patients. The primary outcome is the occurrence of PPCs over 5 consecutive days after the surgery, or until discharge from the hospital. Secondary outcomes include the composite conditions of PPCs, in-hospital stay, systematic inflammation tested by blood samples, and changes in aeration compartments in the ventilated lung as assessed by CT scans. We aim to evaluate the association of mean MP and the temporal patterns in the trend of MP during OLV with the occurrence of PPCs. A total of 120 patients will be enrolled in this study. The study protocol has received approval from the Ethics Committee of the affiliated hospital of Southwest Medical University, China (Reference number: KY2022162). The findings will be made available to the funder and researchers via scientific conferences and peer-reviewed publications. This controlled trial was approved by the Ethics Committee of Southwest Medical University(ChiCTR2200062173), and registered in the Chinese Clinical Trial Register website ( http://www.chictr.org.cn/edit.aspx?pid=172533&htm=4 , ChiCTR2200062173). A written consent was obtained from each patient.
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Affiliation(s)
- Ying-Ying Zhang
- Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Yu-Mei Zhang
- Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Song-Lin Wu
- Department of Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Min Wei
- Department of Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Zhi-Peng Deng
- Faculty of Computer Science, Technical University of Dresden, Dresden, Germany
| | - Xian-Ying Lei
- Department of Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yi-Ping Bai
- Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China.
| | - Xiao-Bin Wang
- Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China.
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Heybati K, Zhou F, Baltazar M, Poudel K, Ochal D, Ellythy L, Deng J, Chelf CJ, Welker C, Ramakrishna H. Appraisal of Postoperative Outcomes of Volatile and Intravenous Anesthetics: A Network Meta-Analysis of Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:2215-2222. [PMID: 37573213 DOI: 10.1053/j.jvca.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To determine the relative efficacy of specific regimens used as primary anesthetics, as well as the potential combination of volatile and intravenous anesthetics among patients undergoing cardiac, thoracic, and vascular surgery. DESIGN This frequentist, random-effects network meta-analysis was registered prospectively (CRD42022316328) and conducted according to the PRISMA-NMA framework. Literature searches were conducted up to April 1, 2022 across relevant databases. Risk of bias (RoB) and confidence of evidence were assessed by RoB-2 and CINeMA, respectively. Pooled treatment effects were compared with propofol monotherapy. SETTING Fifty-three randomized controlled trials (N = 8,085) were included, of which 46 trials (N = 6,604) enrolled patients undergoing cardiac surgery. PARTICIPANTS Trials enrolling adults (≥18) undergoing cardiac, thoracic, and vascular surgery, using the same induction regimens, and comparing volatile and/or total intravenous anesthesia for the maintenance of anesthesia. Given that the majority of trials focused on those undergoing cardiac surgery and the heterogeneity, analyses were restricted to this population. MEASUREMENT AND MAIN RESULTS Outcomes of interest included intensive care unit (ICU) length of stay (LOS), myocardial infarction, in-hospital and 30-day mortality, stroke, and delirium. Across 19 trials (N = 1,821; 9 arms; I2 = 64.5%), sevoflurane combined with propofol decreased ICU LOS (mean difference [MD] -18.26 hours; 95% CI -34.78 to -1.73 hours), whereas midazolam with propofol (MD 17.51 hours; 95% CI 2.78-32.25 hours) was associated with a significant increase in ICU LOS, when compared with propofol monotherapy. Among 27 trials (N = 4,080; 10 arms; I2 = 0%), midazolam was associated with significantly greater risk of myocardial infarction versus propofol (risk ratio 1.94; 95% CI 1.01-3.71). There were no significant differences across other outcomes. CONCLUSION In patients undergoing cardiac surgery, sevoflurane with propofol was associated with decreased ICU LOS compared with propofol monotherapy. Midazolam with propofol increased ICU LOS compared with propofol alone. The combined use of intravenous and volatile anesthetics should be explored further. Future trials in thoracic and vascular surgery are warranted.
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Affiliation(s)
- Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Keshav Poudel
- Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN
| | - Domenic Ochal
- Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN
| | - Luqman Ellythy
- Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN
| | - Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Carson Welker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic - Rochester, Rochester, MN
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic - Rochester, Rochester, MN.
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9
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Guo X, Ke W, Yang X, Zhao X, Li M. Association of DLT versus SLT with postoperative pneumonia during esophagectomy in China: a retrospective comparison study. BMC Anesthesiol 2023; 23:301. [PMID: 37670237 PMCID: PMC10478392 DOI: 10.1186/s12871-023-02252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Double lumen tube (DLT) and single lumen tube (SLT) are two common endotracheal tube (ETT) types in esophageal cancer surgery. Evidence of the relationship between two ETT types and postoperative pneumonia (PP) remains unclear. We aimed to determine the association between two types of ETT (DLT and SLT) and PP and assess the perioperative risk-related parameters that affect PP. METHODS This study included 680 patients who underwent esophageal cancer surgery from January 01, 2010 through December 31, 2020. The primary outcome was PP, and the secondary outcome was perioperative risk-related parameters that affect PP. The independent variable was the type of ETT: DLT or SLT. The dependent variable was PP. To determine the relationship between variables and PP, univariate and multivariate analyses were performed. The covariables included baseline demographic characteristics, comorbidity disease, neoadjuvant chemotherapy, tumor location, laboratory parameters, intraoperative related variables. RESULTS In all patients, the incidence of postoperative pneumonia in esophagectomy was 32.77% (36.90% in DLT group and 26.38% in SLT group). After adjusting for potential risk factors, we found that using an SLT in esophagectomy was associated with lower risk of postoperative pneumonia compared to using a DLT (Odd ratio = 0.41, 95% confidence interval (CI): 0.22, 0.77, p = 0.0057). Besides DLT, smoking history, combined intravenous and inhalation anesthesia (CIIA) and vasoactive drug use were all significant and independent risk factors for postoperative pneumonia in esophagectomy. These results remained stable and reliable after subgroup analysis. CONCLUSIONS During esophagectomy, there is significant association between the type of ETT (DLT or SLT) and PP. Patients who were intubated with a single lumen tube may have a lower rate of postoperative pneumonia than those who were intubated with a double lumen tube. This finding requires verification in follow-up studies.
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Affiliation(s)
- Xukeng Guo
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China
| | - Weiqi Ke
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China
| | - Xin Yang
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China
| | - Xinying Zhao
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China
| | - Meizhen Li
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping District, Shantou City, Guangdong Province, China.
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Boisen ML, Fernando RJ, Alfaras-Melainis K, Hoffmann PJ, Kolarczyk LM, Teeter E, Schisler T, Ritchie PJ, La Colla L, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2021. J Cardiothorac Vasc Anesth 2022; 36:4252-4265. [PMID: 36220681 DOI: 10.1053/j.jvca.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Paul J Hoffmann
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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11
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Ștefan M, Predoi C, Goicea R, Filipescu D. Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review. J Clin Med 2022; 11:jcm11206031. [PMID: 36294353 PMCID: PMC9604446 DOI: 10.3390/jcm11206031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
Recent research has contested the previously accepted paradigm that volatile anaesthetics improve outcomes in cardiac surgery patients when compared to intravenous anaesthesia. In this review we summarise the mechanisms of myocardial ischaemia/reperfusion injury and cardioprotection in cardiac surgery. In addition, we make a comprehensive analysis of evidence comparing outcomes in patients undergoing cardiac surgery under volatile or intravenous anaesthesia, in terms of mortality and morbidity (cardiac, neurological, renal, pulmonary).
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Affiliation(s)
- Mihai Ștefan
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Correspondence:
| | - Cornelia Predoi
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Goicea
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Filipescu
- Department of Anaesthesiology and Intensive Care, “Prof Dr CC Iliescu” Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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12
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Liu W, Jin F, Wang HM, Yong FF, Wu Z, Jia HQ. The association between double-lumen tube versus bronchial blocker and postoperative pulmonary complications in patients after lung cancer surgery. Front Oncol 2022; 12:1011849. [PMID: 36237329 PMCID: PMC9552823 DOI: 10.3389/fonc.2022.1011849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both double-lumen tube (DLT) and bronchial blocker (BB) are used for lung isolation in patients undergoing lung cancer surgery. However, the effects of different devices for lung isolation remain inconclusive. Present study was designed to investigate the association between the choice of the two devices and postoperative pulmonary complications (PPCs) in patients with lung cancer. Methods In this retrospective cohort study, patients who underwent lung cancer surgery between January 1, 2020 and October 31, 2020 were screened. Patients were divided into two groups according to different devices for lung isolation: DLT group and BB group. Primary outcome was the incidence of a composite of PPCs during postoperative in-hospital stay. Results A total of 1721 were enrolled for analysis, of them, 868 received DLT and 853 BB. A composite of PPCs was less common in patients with BB (25.1%, [214/853]) than those received DLT (37.9% [329/868] OR 0.582 95% CI 0.461-0.735 P < 0.001). Respiratory infection was less common in BB group (14.4%, [123/853]) than DLT group (30.3%, [263/868], P<0.001). The incidence of non-PPCs complications was not statistically significant between the 2 groups. Conclusions For patients undergoing surgery for lung cancer, the use of BB for lung isolation was associated with a reduced risk of PPCs when compared with DLT.
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Affiliation(s)
- Wei Liu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fan Jin
- Department of Anesthesiology, Zhuji People’s Hospital, Shaoxing, China
| | - He-Mei Wang
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang-Fang Yong
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen Wu
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Qun Jia
- Department of Anesthesiology, The Forth hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Hui-Qun Jia,
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13
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Yu H, Tian W, Xu Z, Jiang R, Jin L, Mao W, Chen Y, Yu H. Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial. BMC Anesthesiol 2022; 22:253. [PMID: 35941536 PMCID: PMC9358799 DOI: 10.1186/s12871-022-01785-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Opioids remain the mainstream therapy for post-surgical pain. The choice of opioids administered by patient-controlled intravenous analgesia (PCIA) for thoracoscopic lung surgery is unclear. This study compared 3 opioid analgesics for achieving satisfactory analgesia with minimal emesis (SAME). Methods This randomized clinical trial enrolled patients scheduled for thoracoscopic lung surgery randomized to receive 1 of 3 opioids for PCIA: oxycodone (group O), hydromorphone (group H), and sufentanil (group S). The primary outcome was the proportion of subjects achieving SAME, i.e., no-to-mild pain (pain score < 4/10) with minimal nausea/vomiting (PONV score < 2/4) when coughing during the pulmonary rehabilitation exercise in the first 3 postoperative days. Results Of 555 enrolled patients, 184 patients in group O, 186 in group H and 184 in group S were included in the final analysis. The primary outcome of SAME was significantly different among group O, H and S (41.3% vs 40.3% vs 29.9%, P = 0.043), but no difference was observed between pairwise group comparisons. Patients in groups O and H had lower pain scores when coughing on the second day after surgery than those in group S, both with mean differences of 1 (3(3,4) and 3(3,4) vs 4(3,4), P = 0.009 and 0.039, respectively). The PONV scores were comparable between three groups (P > 0.05). There were no differences in other opioid-related side effects, patient satisfaction score, and QoR-15 score among three groups. Conclusions Given clinically relevant benefits detected, PCIA with oxycodone or hydromorphone is superior to sufentanil for achieving SAME as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery. Trial registration This study was registered at (ChiCTR2100045614, 19/04/2021). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01785-4.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University. No, 37 Guoxue Alley, Chengdu, 610041, China
| | - Wei Tian
- Department of Anesthesiology, The First People's Hospital of Neijiang, Neijiang, 641000, China
| | - Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University. No, 37 Guoxue Alley, Chengdu, 610041, China
| | - Rongjuan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, 610017, China
| | - Liang Jin
- Department of Anesthesiology, The People's Hospital of Leshan, Leshan, 614099, China
| | - Wenjie Mao
- Department of Anesthesiology, The People's Hospital of Jianyang, Chengdu, 641499, China
| | - Ying Chen
- Department of Anesthesiology, Liangshan Hospital of Integrated Traditional and Western Medicine, Xichang, 615099, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University. No, 37 Guoxue Alley, Chengdu, 610041, China.
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14
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He LL, Li XF, Jiang JL, Yu H, Dai SH, Jing WW, Yu H. Effect of Volatile Anesthesia versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial. J Cardiothorac Vasc Anesth 2022; 36:3758-3765. [DOI: 10.1053/j.jvca.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
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15
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Shi W, Chen Y, Zhang MQ, Che GW, Yu H. Effects of methylprednisolone on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized controlled trial. J Clin Anesth 2021; 75:110526. [PMID: 34610541 DOI: 10.1016/j.jclinane.2021.110526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE Evidence from previous studies indicates that glucocorticoids offer effective postoperative analgesia and improve the quality of recovery (QoR). The aim of this study was to evaluate the efficacy of preoperative methylprednisolone on early postoperative pain and QoR following thoracoscopic lung surgery. DESIGN A prospective, single-center, three-arm, double-blinded, randomized trial. SETTING Tertiary university hospital. PATIENTS Adult patients aged ≥18 years undergoing thoracoscopic lung surgery were eligible for participation. INTERVENTIONS Patients enrolled in this study were randomized to receive preoperative methylprednisolone (40 mg or 120 mg) or identical volumes of 0.9% saline. MEASUREMENTS The primary outcome was the proportion of moderate-to-severe pain (numerical rating scale [NRS] ≥ 4 when coughing during pulmonary rehabilitation exercises) on the first day postoperatively. The postoperative pain scores, QoR-15 scores and other secondary outcomes were also recorded. MAIN RESULTS Of the 180 enrolled patients, 173 patients were included in the primary analysis. The results showed that the proportion of moderate-to-severe pain was not significantly different between the combined methylprednisolone group and the placebo group (51.7% vs. 64.9%; absolute difference, 13.2%; 95% CI, -2.1% to 29.3%; P = 0.10). Patients who received methylprednisolone treatment had lower pain scores at rest and coughing on the first day after surgery than those who received placebo treatment, with mean differences of 0.5 and 0.7, respectively (P < 0.01). QoR-15 scores were higher in patients treated with methylprednisolone at day 1 (mean difference, 6.9; P < 0.001) and day 2 (mean difference, 7.2; P < 0.001) than in patients who received placebo treatment. No side-effects associated with methylprednisolone treatment were observed. CONCLUSIONS Our findings suggested that preoperative methylprednisolone (either high or low dose) has limited impact on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery, with no clinically relevant benefits detected when compared with placebo. TRIAL REGISTRATION Chinese Clinical Trail Register (identifier: ChiCTR1900021020).
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Affiliation(s)
- Wei Shi
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ying Chen
- Department of Anesthesiology, Hospital of Integrated Traditional Chinese and Western Medicine of Liangshan Prefecture, Liangshan 615000, Sichuan, China
| | - Meng-Qiu Zhang
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hai Yu
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
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