Comparison of Pulmonary Morbidity Using Sevoflurane or Propofol-Remifentanil Anesthesia in an Ivor Lewis Operation

ObjectiveAn inhalation anesthetic–induced attenuation effect on the inflammatory reaction during one-lung ventilation (OLV) has been reported. Pulmonary inflammation is a substantive prognostic factor for Ivor Lewis operations. Blood inflammatory parameters and postoperative pulmonary complications between sevoflurane and propofol-remifentanil anesthesia in patients undergoing Ivor Lewis operations were compared.DesignA prospective, randomized study.SettingA medical university.ParticipantsForty-eight patients undergoing Ivor Lewis operation allocated randomly into 2 groups.InterventionsPatients received sevoflurane or total intravenous anesthesia using propofol and remifentanil (n = 24 per group).Measurements and Main ResultsBlood interleukin-6 (IL-6), malondialdehyde (MDA), oxygenation, abnormalities on a chest radiograph (CXR), extubation, intensive care unit (ICU) stay, length of hospitalization, and postoperative complications were compared between the 2 anesthetic techniques. The level of IL-6 at the end of surgery was lower for sevoflurane (69.5 [35.9-121.0] pg/mL) than propofol-remifentanil (128.2 [92.8-163.8] pg/mL, p = 0.03), but this difference was not maintained 24 hours after surgery. Frequencies of abnormalities measured by a CXR, PaO2/FIO2<300, and PaCO2 <50 mmHg until discharge, the postoperative highest C-reactive protein level, white blood cells, and MDA did not differ between the 2 anesthetics. No differences in the extubation time, ICU stay, discharge day, or the incidence of hospital complications between sevoflurane and propofol-remifentanil anesthesia techniques were observed.ConclusionsSevoflurane anesthesia attenuated an increase in blood IL-6 at the end of surgery but did not provide any advantages over propofol remifentanil in terms of postoperative pulmonary complications in Ivor Lewis operations.