Background and Goal of Study: Recent studies report the immunomodulatory role of halogenated anesthetics during lung resection surgery (LRS) but fail to investigate differences in clinical practice with respect to prognosis. The main goal of the present study was to compare the effect of sevoflurane and propofol on the incidence of postoperative pulmonary complications (PPCs) in patients undergoing LRS. The difference in lung and systemic inflammatory response was the secondary objective.
Materials and methods: We designed a randomized controlled trial (NCT 02168751; EudraCT 2011-002294-29), approved by the local ethics committee. We included 180 patients undergoing LRS. All of the patients fulfilled the inclusion criteria. Patients were randomized to two groups depending on the anesthetic used (propofol or sevoflurane). The patients were managed with the same anesthetic protocol. Double-lung ventilation was performed with the following settings: volume-controlled ventilation (VCV), tidal volume (Vt) 8 ml/kg, PEEP 5 cmH2O, FiO2 0.4-0.5 and respiratory rate to maintain EtCO230-35 mmHg. One-lung ventilation (OLV) was performed by applying Vt 6 ml/kg, PEEP 5 cmH20, permissive hypercapnia, and FiO2 0.6-1 to maintain SaO2>90%. Fiberoptic bronchoalveolar lavage (BAL) was performed in both lungs before and after OLV for analysis of inflammatory markers. Arterial blood was drawn for measurement of respiratory gases and the same inflammatory markers analyzed in BAL at 5 time points: baseline (before OLV); 30 min after initiation of OLV; at the end of OLV; and 6 and 18h after surgery. Release of inflammatory markers was measured using Western Blot. The t test and the chi-square test were used for the statistical analysis. We recorded postoperative care unit stay, hospital stay, mortality during the 1st month and year, and PPCs classified following the definition applied in the ARISCAT study.
Results and discussion: Expression of lung and systemic proinflammatory cytokines were more pronounced and 1styear mortality was higher in the propofol group than in the sevoflurane group (p< 0.05). Pulmonary and systemic release of the anti-inflammatory cytokine IL-10 was less pronounced in the propofol group (p< 0.05). More PPCs were detected in the propofol group (28.4% vs 14%, OR 2.44 [95% CI, 1.14-5.26]). 
Conclusion: Our results suggest sevoflurane during LRS reduces the frequency of PPCs owing to its immunomodulatory role in the pulmonary and systemic inflammatory responses.

Sevoflurane, not propofol, during lung resection surgery reduces the incidence of postoperative pulmonary complications. A randomized controlled trial