Perioperative Medicine  |   August 2016
Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?: A Multicenter Randomized Controlled Trial
Author Notes
  • From the Institute of Anesthesiology (B.B.-S., J.M.B.) and Department of Thoracic Surgery (W.W., D.S.), University Hospital Zurich, Zurich, Switzerland; Institute of Physiology, Zurich Center for Integrative Human Physiology (B.B.-S.), and Epidemiology, Biostatistics and Prevention Institute (J.B., M.P.), University of Zurich, Zurich, Switzerland; Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois (B.B.-S.); Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland (M.S.); Department of Anesthesiology and Intensive Care Medicine, Kantonsspital Muensterlingen (Cantonal Hospital of Muensterlingen), Muensterlingen, Switzerland (T.A.N., T.J.R.); Department of Anesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland (F.S., A.V.); and Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), St. Gallen, Switzerland (M.F.). Current position: Institute of Anesthesia and Intensive Care, Klinik Hirslanden Zurich, Zurich, Switzerland (M.S.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • B.B.-S. and J.M.B. contributed equally as first authors. M.F. and M.P. contributed equally as last authors.
    B.B.-S. and J.M.B. contributed equally as first authors. M.F. and M.P. contributed equally as last authors.×
  • Submitted for publication October 13, 2015. Accepted for publication April 13, 2016.
    Submitted for publication October 13, 2015. Accepted for publication April 13, 2016.×
  • Address correspondence to Dr. Beck-Schimmer: Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. beatrice.beckschimmer@uzh.ch. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pharmacology / Respiratory System / Thoracic Anesthesia
Perioperative Medicine   |   August 2016
Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?: A Multicenter Randomized Controlled Trial
Anesthesiology 8 2016, Vol.125, 313-321. doi:10.1097/ALN.0000000000001164
Anesthesiology 8 2016, Vol.125, 313-321. doi:10.1097/ALN.0000000000001164
Abstract

Background: One-lung ventilation during thoracic surgery is associated with hypoxia–reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia–induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications.

Methods: Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age.

Results: Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71).

Conclusions: This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.