Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial

A double-blinded randomized controlled clinical trial

Authors

  • Alireza Sharifian Attar M.D., Anesthesiologist, Associate Professor, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Keywords:

Hypoxemia, One-Lung Ventilation, Propofol, Isoflurane, Oxygenation

Abstract

Background: The use of anesthetic drugs with minimal inhibitory effects on the hypoxic pulmonary vasoconstriction (HPV) could have a decisive role in preventing the hypoxemia during one-lung ventilation (OLV).  Objective: The aim of this study was to compare the effects of propofol and isoflurane on the changes in gas exchange parameters following OLV in thoracic surgery. Methods: This double-blinded randomized controlled clinical trial was conducted on patients who were candidates for elective right thoracotomy referred to the central operating room of Ghaem Hospital in Mashhad, Iran, during February 2016-2017. Patients with age range of 18 to 75 years, class I and II American Society of Anesthesiologists (ASA) and thoracotomy with OLV for pulmonary resection or cyst drainage were included. The patients were randomly allocated (1:1 ratio) into two groups of propofol (P, 50-100μg/kg/min) and isoflurane (I, 1 minimum alveolar concentration (MAC) 1.1%). Partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), end-tidal carbon dioxide (ETCO2) and arterial oxygen saturation (SPO2) were recorded before and 15 minutes after OLV and compared between the two groups. The comparison of the mean gas exchange parameters before and 15 minutes after OLV was performed using Mann-Whitney test in SPSS version 19 software. P<0.05 was considered statistically significant.  Results: In this study, 122 patients with mean age of 59.4±14.1 years (two groups of 61) were studied. Both groups were matched for age or gender. The two groups had no significant difference in the gas exchange parameters before the OLV. Only PaCO2 (p=0.001) and ETCO2 (p=0.001) were significantly higher in the propofol group after 15 minutes OLV than in the isoflurane group. However, PaO2 (p=0.67), O2Sat (p=0.333) and PaCO2-ETCO2 gradient (p=0.809) showed no significant difference between the two groups at this minute. Conclusion: Based on the results of this study, the propofol or isoflurane selection seems to have no significant effect on the arterial oxygenation. On the other hand, isoflurane and propofol could be an appropriate anesthetic for thoracic surgery by normalizing the carbon dioxide gradient range during the OLV. Clinical Trial Registration: The study was also registered at the Iranian Registry of Clinical Trials (IRCT2015123013159N8). Funding: The study was financially supported by the Deputy of Research of Mashhad University of Medical Sciences (grant number: 940119).

References

McGrath B, Tennuci C, Lee G. The History of One-Lung Anesthesia and the Double-Lumen Tube. Journal

of anesthesia history. 2017; 3(3): 76-86. PMID: 28842155.

Ng A, Swanevelder J. Hypoxaemia during one-lung anaesthesia. Continuing Education in Anaesthesia

Critical Care & Pain. 2010; 10(4): 117-22. doi: 10.1093/bjaceaccp/mkq019.

Purohit A, Bhargava S, Mangal V, Parashar VK. Lung isolation, one-lung ventilation and hypoxaemia

during lung isolation. Indian journal of anaesthesia. 2015; 59(9): 606-17. doi: 10.4103/0019-5049.165855.

PMID: 26556920. PMCID: PMC4613408.

Karzai W, Schwarzkopf K. Hypoxemia during One-lung Ventilation Prediction, Prevention, and Treatment.

The Journal of the American Society of Anesthesiologists. 2009; 110(6): 1402-11.

Sharifian Attar A, Tabari M, Rahnamazadeh M, Salehi M. A comparison of effects of propofol and

isoflurane on arterial oxygenation pressure, mean arterial pressure and heart rate variations following onelung ventilation in thoracic surgeries. Iran Red Crescent Med J. 2014; 16(2): e15809. doi:

5812/ircmj.15809. PMID: 24719749, PMCID: PMC3965882.

Cho YJ, Kim TK, Hong DM, Seo JH, Bahk JH, Jeon Y. Effect of desflurane-remifentanil vs. Propofolremifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a

prospective randomized trial. BMC anesthesiology. 2017; 17(1): 9. doi: 10.1186/s12871-017-0302-x. PMID: 28100177 PMCID: PMC5242054.

Della Rocca G, Coccia C. Ventilatory management of one-lung ventilation. Minerva anestesiologica. 2011;

(5): 534-6. PMID: 21540809.

Dunham-Snary KJ, Wu D, Sykes EA, Thakrar A, Parlow LR, Mewburn JD, et al. Hypoxic pulmonary

vasoconstriction: from molecular mechanisms to medicine. CHEST. 2017; 151(1): 181-92. doi:

1016/j.chest.2016.09.001. PMID: 27645688, PMCID: PMC5310129.

Swenson ER. Hypoxic pulmonary vasoconstriction. High altitude medicine & biology. 2013; 14(2): 101- 10. doi: 10.1089/ham.2013.1010. PMID: 23795729.

Lumb AB, Slinger P. Hypoxic Pulmonary VasoconstrictionPhysiology and Anesthetic Implications.

Anesthesiology. 2015; 122(4): 932-46. doi: 10.1097/ALN.0000000000000569. PMID: 25587641.

Tarry D, Powell M. Hypoxic pulmonary vasoconstriction. BJA Education. 2017: mkw076.

Beck DH, Doepfmer UR, Sinemus C, Bloch A, Schenk MR, Kox WJ. Effects of sevoflurane and propofol

on pulmonary shunt fraction during one-lung ventilation for thoracic surgery. Br J Anaesth. 2001; 86(1):

-43. PMID: 11575407.

Iwata M, Inoue S, Kawaguchi M, Takahama M, Tojo T, Taniguchi S, et al. Jugular Bulb Venous Oxygen

Saturation During One-Lung Ventilation Under Sevoflurane- or Propofol-Based Anesthesia for Lung

Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2008; 22(1): 71-6.

Jin Y, Zhao X, Li H, Wang Z, Wang D. Effects of sevoflurane and propofol on the inflammatory response

and pulmonary function of perioperative patients with one-lung ventilation. Experimental and therapeutic

medicine. 2013; 6(3): 781-5. doi: 10.3892/etm.2013.1194. PMID: 24137265, PMCID: PMC3786802.

Karci A, Duru S, Hepağuşlar H, Çiftçi L, Yilmaz O. Comparison of the effect of sevoflurane and propofol

on oxygenation during gradual transition to one-lung ventilation. Brazilian Journal of Anesthesiology.

; 64(2): 79-83.

Schwarzkopf K, Hueter L, Schreiber T, Preussler NP, Loeb V, Karzai W. Oxygenation during one-lung

ventilation with propofol or sevoflurane. Middle East J Anaesthesiol. 2009; 20(3): 397-400. PMID:

Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law-Koune JD, Laloe PA, et al. Effects of propofol vs

sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth. 2007; 98(4): 539-44. doi:

1093/bja/aem039. PMID: 17347180.

Reid CW, Slinger PD, Lenis S. A comparison of the effects of propofol-alfentanil versus isoflurane

anesthesia on arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth. 1996; 10(7):

-3. doi: 10.1016/S1053-0770(96)80046-2. PMID: 8969391.

Schwarzkopf K, Schreiber T, Preussler NP, Gaser E, Huter L, Bauer R, et al. Lung perfusion, shunt

fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and

propofol. J Cardiothorac Vasc Anesth. 2003; 17(1): 73-5. doi: 10.1053/jcan.2003.13. PMID: 12635064.

Reid CW, Slinger PD, Lenis S. A comparison of the effects of propofol-alfentanil versus isoflurane

anesthesia on arterial oxygenation during one-lung ventilation. Journal of cardiothoracic and vascular

anesthesia. 1996; 10(7): 860-3. doi: 10.1016/S1053-0770(96)80046-2.

Abe K, Mashimo T, Yoshiya I. Arterial Oxygenation and Shunt Fraction During One-Lung Ventilation: A

Comparison of Isoflurane and Sevoflurane. Anesthesia & Analgesia. 1998; 86(6): 1266-70. PMID:

-199806000-00025.

Abe K, Shimizu T, Takashina M, Shiozaki H, Yoshiya I. The Effects of Propofol, Isoflurane, and

Sevoflurane on Oxygenation and Shunt Fraction During One-Lung Ventilation. Anesth Analg. 1998; 87(5):

-9. PMID: 9806702.

Karzai W, Haberstroh J, Priebe HJ. Effects of desflurane and propofol on arterial oxygenation during onelung ventilation in the pig. Acta anaesthesiol Scand. 1998; 42(6): 648-52. doi: 10.1111/j.1399- 6576.1998.tb05296.x. PMID: 9689269.

Pagel PS, Fu JL, Damask MC, Davis RF, Samuelson PN, Howie MB, et al. Desflurane and Isoflurane

Produce Similar Alterations in Systemic and Pulmonary Hemodynamics and Arterial Oxygenation in

Patients Undergoing One-Lung Ventilation During Thoracotomy. Anesth Analg. 1998; 87(4): 800-7.

PMID: 9768773.

Wang JY, Russell GN, Page RD, Jackson M, Pennefather SH. Comparison of the effects of sevoflurane and

isoflurane on arterial oxygenation during one lung ventilation. Br J Anaesth. 1998; 81(6): 850-3. doi:

1093/bja/81.6.850. PMID: 10211007.

Sugasawa Y, Yamaguchi K, Kumakura S, Murakami T, Suzuki K, Nagaoka I, et al. Effects of sevoflurane

and propofol on pulmonary inflammatory responses during lung resection. Journal of Anesthesia. 2012;

(1): 62-9. doi: 10.1007/s00540-011-1244-y. PMID: 21979104.

Schwarzkopf K, Hueter L, Schreiber T, Preussler N, Loeb V, Karzai W. Oxygenation during one-lung

ventilation with propofol or sevoflurane. Middle East J Anaesthesiol. 2009; 20(3): 397-400. PMID:

Huang CH, Wang YP, Wu PY, Chien CT, Cheng YJ. Propofol infusion shortens and attenuates oxidative

stress during one lung ventilation. Acta Anaesthesiologica Taiwanica. 2008; 46(4): 160-5. doi:

1016/S1875-4597(09)60003-5.

Erturk E, Topaloglu S, Dohman D, Kutanis D, Beşir A, Demirci Y, et al. The Comparison of the Effects of

Sevoflurane Inhalation Anesthesia and Intravenous Propofol Anesthesia on Oxidative Stress in One Lung

Ventilation. Biomed Res Int. 2014; 2014: 360936. doi: 10.1155/2014/360936. PMID: 24527444, PMCID:

PMC3909970.

Published

2021-12-24