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Effects of volatile vs. propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilation: a meta-analysis of randomized controlled trials

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Abstract

Objective

The aim of this meta-analysis is to compare the potential effects of inhalation anesthetics with total intravenous anesthetics on alveolar cytokine expression and lung-related clinical outcomes in patients undergoing one-lung ventilation (OLV) for thoracic surgery.

Methods

We retrieved the PubMed, EMBASE, and the Cochrane Library respectively to identify randomized controlled trials comparing different anesthetics (volatile anesthetics vs. intravenous anesthetics) on the pulmonary inflammatory response to OLV. The primary outcomes were the levels of alveolar concentrations of inflammatory cytokines.

Results

Eight randomized controlled trials that included 365 patients were screened. Overall, there were significant differences in the concentration of alveolar inflammatory mediators between volatile group and intravenous group, in which volatile group had lower levels of TNF-α (SMD −1.51; 95 % CI −2.15 to −0.87; p < 0.001), IL-6 (SMD −0.70; 95 % CI −0.99 to −0.41; p < 0.001) and IL-8 (SMD −1.32; 95 % CI −2.20 to −0.45; p = 0.003). The overall number of pulmonary complications in the volatile group was smaller (RR 0.42; 95 % CI 0.23–0.77; p = 0.005) and patients in that group had significantly abridged hospitalization stay (WMD −3.59 days; 95 % CI −5.70 to −1.48 days; p = 0.001).

Conclusions

Inhalation anesthetics might be preferable in patients undergoing OLV for thoracic surgery and their protective effects might work via attenuating inflammatory responses.

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The authors have no conflict of interests regarding the work.

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    Authors and Affiliations

    1. Department of Transfusion Medicine, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

      Bin Sun, Yan Zang, Haihui Gu & Baohua Qian

    2. Jiangsu Key Laboratory of Anesthesiology and Jiangsu Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical College, Xuzhou, Jiangsu, China

      Jinfeng Wang

    3. Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China

      Lulong Bo & Jinbao Li

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    1. Bin Sun
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    Correspondence to Baohua Qian.

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    B. Sun and J. F. Wang contributed equally to this work and should be considered co-first authors.

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    Sun, B., Wang, J., Bo, L. 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 29, 570–579 (2015). https://doi.org/10.1007/s00540-015-1987-y

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    • DOI: https://doi.org/10.1007/s00540-015-1987-y

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