Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Leilei , JIANG Jiali , DAI Shunhui ,  YU Hai

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Anesthetics; sevoflurane; desflurane; propofol; cardiopulmonary bypass; cardiac surgery; postoperative pulmonary complications

DOI：

10.7507/1007-4848.202007022

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB).Methods The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay.Results There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05).Conclusion No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.

Citation： HE Leilei, JIANG Jiali, DAI Shunhui, YU Hai. Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 339-343. doi: 10.7507/1007-4848.202007022 Copy

1.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
3.	Deng QW, Tan WC, Zhao BC, et al. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: A network meta-analysis of randomised controlled trials. Br J Anaesth, 2020, 124(3): 324-335.
4.	Strosing KM, Faller S, Gyllenram V, et al. Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury. Anesth Analg, 2016, 123(1): 143-151.
5.	de la Gala F, Piñeiro P, Reyes A, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth, 2017, 119(4): 655-663.
6.	Uhlig C, Bluth T, Schwarz K, et al. Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis. Anesthesiology, 2016, 124(6): 1230-1245.
7.	O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
8.	Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
9.	von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
10.	Landis RC, Brown JR, Fitzgerald D, et al. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: A critical review of the evidence base. J Extra Corpor Technol, 2014, 46(3): 197-211.
11.	Yu QB, Li HM, Li LL, et al. Sevoflurane downregulates interleukin-6 and interleukin-8 levels in patients after cardiopulmonary bypass surgery: a meta-analysis. Genet Mol Res, 2015, 14(4): 19016-19027.
12.	Balogh AL, Peták F, Fodor GH, et al. Sevoflurane relieves lung function deterioration after cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2017, 31(6): 2017-2026.
13.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
14.	Bonanni A, Signori A, Alicino C, et al. Volatile anesthetics versus propofol for cardiac surgery with cardiopulmonary bypass: Meta-analysis of randomized trials. Anesthesiology, 2020, 132(6): 1429-1446.
15.	黑飞龙, 朱德明, 侯晓彤, 等. 2016年中国心脏外科手术和体外循环数据白皮书. 中国体外循环杂志, 2017, 15(2): 65-67.
16.	Ozdogan HK, Cetinkunar S, Karateke F, et al. The effects of sevoflurane and desflurane on the hemodynamics and respiratory functions in laparoscopic sleeve gastrectomy. J Clin Anesth, 2016, 35: 441-445.
17.	Klock PA, Czeslick EG, Klafta JM, et al. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology, 2001, 94(6): 963-967.

1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
3. Deng QW, Tan WC, Zhao BC, et al. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: A network meta-analysis of randomised controlled trials. Br J Anaesth, 2020, 124(3): 324-335.
4. Strosing KM, Faller S, Gyllenram V, et al. Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury. Anesth Analg, 2016, 123(1): 143-151.
5. de la Gala F, Piñeiro P, Reyes A, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth, 2017, 119(4): 655-663.
6. Uhlig C, Bluth T, Schwarz K, et al. Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis. Anesthesiology, 2016, 124(6): 1230-1245.
7. O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
8. Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
9. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
10. Landis RC, Brown JR, Fitzgerald D, et al. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: A critical review of the evidence base. J Extra Corpor Technol, 2014, 46(3): 197-211.
11. Yu QB, Li HM, Li LL, et al. Sevoflurane downregulates interleukin-6 and interleukin-8 levels in patients after cardiopulmonary bypass surgery: a meta-analysis. Genet Mol Res, 2015, 14(4): 19016-19027.
12. Balogh AL, Peták F, Fodor GH, et al. Sevoflurane relieves lung function deterioration after cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2017, 31(6): 2017-2026.
13. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
14. Bonanni A, Signori A, Alicino C, et al. Volatile anesthetics versus propofol for cardiac surgery with cardiopulmonary bypass: Meta-analysis of randomized trials. Anesthesiology, 2020, 132(6): 1429-1446.
15. 黑飞龙, 朱德明, 侯晓彤, 等. 2016年中国心脏外科手术和体外循环数据白皮书. 中国体外循环杂志, 2017, 15(2): 65-67.
16. Ozdogan HK, Cetinkunar S, Karateke F, et al. The effects of sevoflurane and desflurane on the hemodynamics and respiratory functions in laparoscopic sleeve gastrectomy. J Clin Anesth, 2016, 35: 441-445.
17. Klock PA, Czeslick EG, Klafta JM, et al. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology, 2001, 94(6): 963-967.

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