Total intravenous anesthesia fails to decrease pulmonary complications after lung resection surgery

In the world of lung resection surgery (LRS), a debate has persisted over whether volatile anesthesia or total intravenous anesthesia (TIVA) holds the upper hand in reducing the risk of postoperative pulmonary complications (PPCs). A recent study conducted at Taipei Veterans General Hospital found no significant difference in the incidence of PPCs in patients undergoing lung resection surgery whether they received TIVA or volatile anesthesia.

This study was published in BMC Anaesthesiology by Fu-Kai-Hsu and colleagues. The researchers' hypothesis was straightforward: they anticipated that TIVA might be associated with a lower incidence of PPCs compared to volatile anesthesia. The study was retrospective and included patients who underwent lung resection surgery at Taipei Veterans General Hospital from January 2016 to December 2020. The patient charts were reviewed, and data on patient characteristics, perioperative features, and postoperative outcomes were meticulously extracted and analyzed. The patients were divided into two groups: TIVA (total intravenous anesthesia) and volatile anesthesia.

The primary outcome of the study was the incidence of postoperative pulmonary complications (PPCs). The study found that there was no statistically significant difference in the incidence of PPCs between the volatile anesthesia and TIVA groups.

• Besides PPCs, the study also looked into secondary outcomes, including the length of hospital stay (LOS) and postoperative nausea and vomiting (PONV).
  
• The TIVA group exhibited a shorter LOS (p < 0.001) compared to the volatile anesthesia group.
• The incidence of PONV was also lower in the TIVA group (4.6%) compared to the volatile anesthesia group (8.2%), with a statistically significant difference (p = 0.041).
• No significant differences were observed in reintubation, 30-day readmission, and re-operation rates between the two groups.

However, the TIVA group enjoyed a shorter hospital stay and a lower incidence of postoperative nausea and vomiting. These findings suggest that TIVA may be a favorable choice for anesthesia maintenance in patients undergoing lung resection surgery, potentially improving postoperative recovery.

The results of this research provide valuable insights for anesthesiologists and surgeons when selecting the appropriate anesthesia method for lung resection surgery. Future studies may delve further into refining anesthesia practices to optimize patient outcomes during and after surgery.

Reference:

Hsu, F.-K., Cheng, H.-W., Teng, W.-N., Hsu, P.-K., Hsu, H.-S., Chang, W.-K., & Ting, C. Total intravenous anesthesia decreases hospital stay but not incidence of postoperative pulmonary complications after lung resection surgery: a propensity score matching study. BMC Anesthesiology,2023;23(1). https://doi.org/10.1186/s12871-023-02260-4