Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
J Cardiothorac Vasc Anesth. 2022 Oct;36(10):3747-3757. doi: 10.1053/j.jvca.2022.04.018. Epub 2022 Apr 20.
To investigate if sevoflurane based anesthesia is superior to propofol in preventing lung inflammation and preventing postoperative pulmonary complications.
Randomized controlled trial.
Single tertiary care university hospital.
Forty adults undergoing cardiac surgery with cardiopulmonary bypass.
Patients were randomized in a 1:1 ratio to anesthetic maintenance with sevoflurane or propofol.
Blood and bronchoalveolar lavage fluid was sampled before and after bypass to measure pulmonary inflammation using a biomarker panel. The change in bronchoalveolar lavage concentration of tumor necrosis factor alpha (TNFα) was the primary outcome. Secondary outcomes included lung inflammation defined as changes in other biomarkers and postoperative pulmonary complications. There were no significant differences between groups in the change in bronchoalveolar lavage TNFα concentration (median [IQR] change, 17.24 [1.11-536.77] v 101.51 [1.47-402.84] pg/mL, sevoflurane v propofol, p = 0.31). There was a significantly lower postbypass concentration of plasma interleukin 8 (median [IQR], 53.92 [34.5-55.91] v 66.92 [53.03-94.44] pg/mL, p = 0.04) and a significantly smaller postbypass increase in the plasma receptor for advanced glycosylation end products (median [IQR], 174.59 [73.59-446.06] v 548.22 [193.15-852.39] pg/mL, p = 0.03) in the sevoflurane group compared with propofol. The incidence of postoperative pulmonary complications was 100% in both groups, with high rates of pleural effusion (17/18 [94.44%] v 19/22 [86.36%], p = 0.39) and hypoxemia (16/18 [88.88%] v 22/22 [100%], p = 0.11).
Sevoflurane anesthesia during cardiac surgery did not consistently prevent lung inflammation or prevent postoperative pulmonary complications compared to propofol. There were significantly lower levels of 2 plasma biomarkers specific for lung injury and inflammation in the sevoflurane group.
研究七氟醚麻醉是否优于异丙酚预防肺部炎症和术后肺部并发症。
随机对照试验。
单所三级护理大学医院。
40 名接受体外循环心脏手术的成年人。
患者以 1:1 的比例随机分为七氟醚或异丙酚维持麻醉。
在体外循环前后采血和支气管肺泡灌洗液，使用生物标志物谱测量肺炎症。肿瘤坏死因子 α（TNFα）支气管肺泡灌洗浓度的变化是主要结果。次要结果包括定义为其他生物标志物变化的肺部炎症和术后肺部并发症。两组间支气管肺泡灌洗 TNFα浓度的变化无显著差异（中位数[IQR]变化，17.24[1.11-536.77]vs 101.51[1.47-402.84]pg/ml，七氟醚 vs 异丙酚，p=0.31）。体外循环后血浆白细胞介素 8 的浓度显著降低（中位数[IQR]，53.92[34.5-55.91]vs 66.92[53.03-94.44]pg/ml，p=0.04），体外循环后血浆晚期糖基化终产物受体的增加幅度显著较小（中位数[IQR]，174.59[73.59-446.06]vs 548.22[193.15-852.39]pg/ml，p=0.03）七氟醚组与异丙酚组相比。两组术后肺部并发症发生率均为 100%，胸腔积液发生率高（17/18[94.44%]vs 19/22[86.36%]，p=0.39）和低氧血症（16/18[88.88%]vs 22/22[100%]，p=0.11）。
与异丙酚相比，心脏手术期间七氟醚麻醉并不能持续预防肺部炎症或术后肺部并发症。七氟醚组有 2 种血浆肺损伤和炎症特异性生物标志物水平显著降低。
