Article description

Summary:

• The present study aimed to evaluate whether sevoflurane was superior to propofol in preventing lung inflammation and postoperative pulmonary complications.
• A randomized controlled trial.
• Forty adults were undergoing cardiac surgery with cardiopulmonary bypass.
• Patients were randomized in a 1:1 ratio to anaesthetic maintenance with sevoflurane or propofol.
• Blood and bronchoalveolar lavage fluid were sampled before and after bypass to measure pulmonary inflammation using a biomarker panel. The primary outcome was the change in bronchoalveolar lavage (BAL) concentration of tumour necrosis factor-alpha (TNF?). 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 BAL TNF? 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 post-bypass 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 post bypass 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:

• Using sevoflurane during cardiac surgery did not consistently prevent lung inflammation or 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.