TY - JOUR
T1 - Anesthetics to Prevent Lung Injury in Cardiac Surgery
T2 - A Randomized Controlled Trial
AU - O'Gara, Brian P.
AU - Shaefi, Shahzad
AU - Gasangwa, Doris V.
AU - Patxot, Melissa
AU - Beydoun, Najla
AU - Mueller, Ariel L.
AU - Sagy, Iftach
AU - Novack, Victor
AU - Banner-Goodspeed, Valerie M.
AU - Kumaresan, Abirami
AU - Shapeton, Alexander
AU - Spear, Kyle
AU - Bose, Somnath
AU - Baedorf Kassis, Elias N.
AU - Gosling, Andre F.
AU - Mahmood, Feroze Ud Den
AU - Khabbaz, Kamal
AU - Subramaniam, Balachundhar
AU - Talmor, Daniel S.
N1 - Funding Information:
This work was supported by the American Society of Anesthesiologists’ Foundation for Anesthesia Education and Research's Mentored Research Training Grant (Recipient—B.P.O. Mentor—D.S.T.). B.S. is supported by NIH R01AG065554. S.S. is supported by NIGMS K08GM134220.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Objectives: To investigate if sevoflurane based anesthesia is superior to propofol in preventing lung inflammation and preventing postoperative pulmonary complications. Design: Randomized controlled trial. Setting: Single tertiary care university hospital. Participants: Forty adults undergoing cardiac surgery with cardiopulmonary bypass. Interventions: Patients were randomized in a 1:1 ratio to anesthetic maintenance with sevoflurane or propofol. Measurements and Main Results: 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). Conclusions: 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.
AB - Objectives: To investigate if sevoflurane based anesthesia is superior to propofol in preventing lung inflammation and preventing postoperative pulmonary complications. Design: Randomized controlled trial. Setting: Single tertiary care university hospital. Participants: Forty adults undergoing cardiac surgery with cardiopulmonary bypass. Interventions: Patients were randomized in a 1:1 ratio to anesthetic maintenance with sevoflurane or propofol. Measurements and Main Results: 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). Conclusions: 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.
UR - http://www.scopus.com/inward/record.url?scp=85133587326&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2022.04.018
DO - 10.1053/j.jvca.2022.04.018
M3 - Article
C2 - 35798633
AN - SCOPUS:85133587326
VL - 36
SP - 3747
EP - 3757
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 10
ER -