Department of Anesthesiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-pai Rd, 11217, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
BMC Anesthesiol. 2023 Oct 17;23(1):345. doi: 10.1186/s12871-023-02260-4.
There is no consensus regarding the superiority of volatile or total intravenous anesthesia (TIVA) in reducing the incidence of postoperative pulmonary complications (PPCs) after lung resection surgery (LRS). Thus, the aim of this study was to investigate the different anesthetic regimens and the incidence of PPCs in patients who underwent LRS. We hypothesized that TIVA is associated with a lower incidence of PPCs than volatile anesthesia.
This was a retrospective cohort study of patients who underwent LRS at Taipei Veterans General Hospital between January 2016 and December 2020. The patients' charts were reviewed and data on patient characteristics, perioperative features, and postoperative outcomes were extracted and analyzed. The patients were categorized into TIVA or volatile anesthesia groups and their clinical data were compared. Propensity score matching was performed to reduce potential selection bias. The primary outcome was the incidence of PPCs, whereas the secondary outcomes were the incidences of other postoperative events, such as length of hospital stay (LOS) and postoperative nausea and vomiting (PONV).
A total of 392 patients each were included in the TIVA and volatile anesthesia groups. There was no statistically significant difference in the incidence of PPCs between the volatile anesthesia and TIVA groups. The TIVA group had a shorter LOS (p < 0.001) and a lower incidence of PONV than the volatile anesthesia group (4.6% in the TIVA group vs. 8.2% in the volatile anesthesia group; p = 0.041). However, there were no significant differences in reintubation, 30-day readmission, and re-operation rates between the two groups.
There was no significant difference between the incidence of PPCs in patients who underwent LRS under TIVA and that in patients who underwent LRS under volatile anesthesia. However, TIVA had shorter LOS and lower incidence of PONV which may be a better choice for maintenance of anesthesia in patients undergoing LRS.
对于减少肺切除术（LRS）后术后肺部并发症（PPCs）的发生率，挥发性或全静脉麻醉（TIVA）是否具有优势，目前尚无共识。因此，本研究旨在探讨不同的麻醉方案与接受 LRS 患者 PPCs 的发生率。我们假设 TIVA 与挥发性麻醉相比，PPCs 的发生率较低。
这是一项回顾性队列研究，纳入了 2016 年 1 月至 2020 年 12 月期间在台北荣民总医院接受 LRS 的患者。回顾患者的病历，并提取和分析患者特征、围手术期特征和术后结果的数据。患者分为 TIVA 或挥发性麻醉组，并比较其临床数据。采用倾向评分匹配法减少潜在选择偏倚。主要结局为 PPCs 的发生率，次要结局为其他术后事件（如住院时间（LOS）和术后恶心和呕吐（PONV））的发生率。
TIVA 和挥发性麻醉组各纳入 392 例患者。两组 PPCs 的发生率无统计学差异。TIVA 组的 LOS 更短（p<0.001），PONV 的发生率低于挥发性麻醉组（TIVA 组 4.6%，挥发性麻醉组 8.2%；p=0.041）。然而，两组之间的再插管、30 天再入院和再次手术率无显著差异。
TIVA 组和挥发性麻醉组接受 LRS 患者的 PPCs 发生率无显著差异。然而，TIVA 组的 LOS 更短，PONV 的发生率更低，对于接受 LRS 的患者维持麻醉可能是更好的选择。
