title: Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?: A Multicenter Randomized Controlled Trial.
abstract: BACKGROUND
  One-lung ventilation during thoracic surgery is associated with hypoxia-reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia-induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications.
  
  
  METHODS
  Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age.
  
  
  RESULTS
  Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71).
  
  
  CONCLUSIONS
  This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.
authors.affiliation: From the Institute of Anesthesiology (B.B.-S., J.M.B.) and Department of Thoracic Surgery (W.W., D.S.), University Hospital Zurich, Zurich, Switzerland; Institute of Physiology, Zurich Center for Integrative Human Physiology (B.B.-S.), and Epidemiology, Biostatistics and Prevention Institute (J.B., M.P.), University of Zurich, Zurich, Switzerland; Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois (B.B.-S.); Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland (M.S.); Department of Anesthesiology and Intensive Care Medicine, Kantonsspital Muensterlingen (Cantonal Hospital of Muensterlingen), Muensterlingen, Switzerland (T.A.N., T.J.R.); Department of Anesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland (F.S., A.V.); and Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), St. Gallen, Switzerland (M.F.). Current position: Institute of Anesthesia and Intensive Care, Klinik Hirslanden Zurich, Zurich, Switzerland (M.S.).
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
authors.forename: John M
authors.initials: JM
authors.lastname: Bonvini
authors.forename: Julia
authors.initials: J
authors.lastname: Braun
authors.forename: Manfred
authors.initials: M
authors.lastname: Seeberger
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Neff
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Risch
authors.forename: Frank
authors.initials: F
authors.lastname: Stüber
authors.forename: Andreas
authors.initials: A
authors.lastname: Vogt
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.forename: Milo
authors.initials: M
authors.lastname: Puhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000077335:Desflurane; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015742:Propofol / Q000009:adverse effects; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol