Abstract
Background
This is an update of a Cochrane Review first published in The Cochrane Library, Issue 2, 2008.
The technique called one‐lung ventilation can confine bleeding or infection to one lung, prevent rupture of a lung cyst or, more commonly, facilitate surgical exposure of the unventilated lung. During one‐lung ventilation, anaesthesia is maintained either by delivering an inhalation anaesthetic to the ventilated lung or by infusing an intravenous anaesthetic. It is possible that the method chosen to maintain anaesthesia may affect patient outcomes. Inhalation anaesthetics may impair hypoxic pulmonary vasoconstriction (HPV) and increase intrapulmonary shunt and hypoxaemia.
Objectives
The objective of this review was to evaluate the effectiveness and safety of intravenous versus inhalation anaesthesia for one‐lung ventilation.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL); The Cochrane Library (2012, Issue 11); MEDLINE (1966 to November 2012); Embase (1980 to November 2012); Literatura Latino‐Americana e do Caribe em Ciências da Saúde (LILACS, 1982 to November 2012) and ISI web of Science (1945 to November 2012), reference lists of identified trials and bibliographies of published reviews. We also contacted researchers in the field. No language restrictions were applied. The date of the most recent search was 19 November 2012. The original search was performed in June 2006.
We reran the search in CENTRAL, MEDLINE, Embase, LILACS, and ISI web of Science in February 2017 and found four potential studies of interest which have been added to a list of 'Studies awaiting Classification' and will be incorporated into the formal review findings during the review update.
Selection criteria
We included randomized controlled trials and quasi‐randomized controlled trials of intravenous (e.g. propofol) versus inhalation (e.g. isoflurane, sevoflurane, desflurane) anaesthesia for one‐lung ventilation in both surgical and intensive care participants. We excluded studies of participants who had only one lung (i.e. pneumonectomy or congenital absence of one lung).
Data collection and analysis
Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information.
Main results
We included in this updated review 20 studies that enrolled 850 participants, all of which assessed surgical participants－no studies investigated one‐lung ventilation performed outside the operating theatre. No evidence indicated that the drug used to maintain anaesthesia during one‐lung ventilation affected participant outcomes. The methodological quality of the included studies was difficult to assess as it was reported poorly, so the predominant classification of bias was 'unclear'.
Authors' conclusions
Very little evidence from randomized controlled trials suggests differences in participant outcomes with anaesthesia maintained by intravenous versus inhalational anaesthesia during one‐lung ventilation. If researchers believe that the type of drug used to maintain anaesthesia during one‐lung ventilation is important, they should design randomized controlled trials with appropriate participant outcomes, rather than report temporary fluctuations in physiological variables.
Plain language summary
Intravenous versus inhalation anaesthesia for one‐lung ventilation
Clinicians may choose to ventilate only one of a patient's two lungs either during surgery or during a period of intensive care. Possible reasons are to facilitate the performance of surgery, to prevent lung rupture, and to prevent contamination of one lung by the other. During one‐lung ventilation, anaesthesia is maintained by delivery of an inhalation anaesthetic, such as sevoflurane, to the ventilated lung, or by infusion of an intravenous anaesthetic, for example, propofol. It is possible that the method chosen to maintain anaesthesia may affect patient outcomes. We included 20 studies that enrolled 850 participants in this updated systematic review. The methodological quality of the included studies was uncertain because of poor reporting. No evidence indicated that the drug used to maintain anaesthesia during one‐lung ventilation affected patient outcomes. Researchers should include outcomes that are important to participants when assessing the effects of anaesthetic technique during one‐lung ventilation. These include adverse postoperative effects, death and intraoperative awareness.
We reran the search in February 2017 and found four potential studies of interest which have been added to a list of 'Studies awaiting Classification' and will be incorporated into the formal review findings during the review update.
Summary of findings
for the main comparison.
| Intravenous compared with inhalation anaesthesia for one‐lung ventilation | |||
|
Patient or population: participants ventilated by one‐lung Settings: Intervention: intravenous anaesthesia Comparison: inhalation anaesthesia | |||
| Outcomes | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) |
|
Death (at one month) Follow‐up: 5 days (De Conno 2009) |
RR 0 (0 to 0) |
54 (1 study) | ⊕⊝⊝⊝ very low |
|
Adverse postoperative outcomes Follow‐up: 5 days (De Conno 2009); 20 minutes after resuming 2LV (Huang 2008) and 15 min after termination of OLV (Egawa 2009). |
RR1.56 (1.07 to 2.29) |
132 (3 studies) | ⊕⊕⊝⊝ low |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio. | |||
| GRADE Working Group grades of evidence: High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||
Background
Description of the condition
This is an update of a Cochrane Review first published in The Cochrane Library, Issue 2, 2008 (Bassi 2008). The original review included nine studies (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Kellow 1995; Pilotti 1999; Rees 1984; Reid 1996; Spies 1991), and no evidence from randomized controlled trials showed differences in patient outcomes with anaesthesia maintained by intravenous versus inhalational anaesthesia during one‐lung ventilation.
Clinicians may choose to ventilate only one of a patient's two lungs during surgery or during a period of intensive care. This technique, called one‐lung ventilation (OLV), can confine bleeding or infection to one lung, prevent rupture of a lung cyst or, more commonly, facilitate surgical exposure of the unventilated lung (Morgan 2001). During OLV, anaesthesia is maintained by delivery of an inhalation anaesthetic to the ventilated lung or by infusion of an intravenous anaesthetic. It is possible that the method chosen to maintain anaesthesia can affect patient outcomes by modifying the physiological changes that occur during OLV.
Blood that flows through the unventilated lung cannot be oxygenated and, therefore, contributes to arterial hypoxaemia. Blood flow through the unventilated lung can be reduced by factors acting outside the lung tissue or by factors acting inside the lung. In addition, impedance of blood flow through the ventilated lung will indirectly affect blood supply to the unventilated lung. Blood supply to the unventilated lung may be reduced by mechanical compression and distortion of the pulmonary vessels, by reduced pulmonary arterial pressure or by reduced right ventricular stroke volume. Blood flow within lung tissue may be reduced by mechanical distortion or by constriction of smaller pulmonary vessels. Pulmonary arterioles contract when the oxygen tension is low, and inhalation anaesthetics and intravenous anaesthetics may affect this 'hypoxic pulmonary vasoconstriction' differently (Friedlander 1994).
Clinically applicable measures used to maintain oxygenation during OLV include high oxygen concentration of inspired air, intermittent inflation or continuous positive airway pressure to the unventilated lung and positive end‐expiratory pressure to the ventilated lung (Saito 2000).
Description of the intervention
The inhalation anaesthetics seem to impair hypoxic pulmonary vasoconstriction (HPV) more than intravenous anaesthetics by increasing intrapulmonary shunt and hypoxaemia (Domino 1986; Loer 1995; Pruszkowski 2007), although this effect might be mediated by an alveolar inflammatory response (Schilling 2011).
How the intervention might work
The level of oxygenation during one‐lung ventilation may be altered by the type of anaesthesia agent used. Abolition of hypoxic pulmonary vasoconstriction by anaesthetic agents has been suggested as a cause of hypoxaemia during anaesthesia. Early studies demonstrated that inhalation anaesthetics inhibited this vasoconstriction whilst injectable agents did not (Marshall 1984).
Studies have compared different types of inhalation agents and inhalation anaesthesia with intravenous agents (Abe 1998a; Benumof 1987; Carlsson 1987; Kellow 1995). No systematic review has summarized the results of these trials.
Why it is important to do this review
Currently there is no straightforward recommendation based on systematic reviews of previous trials of the effects of anaesthetic agents for one‐lung ventilation. The rate of death or morbidity might be particularly high after OLV, so any intervention that reduces this risk would be useful (Harpole 1999; Wada 1998).
Objectives
The objective of this review was to evaluate the effectiveness and safety of intravenous versus inhalation anaesthesia for one‐lung ventilation.
Methods
Criteria for considering studies for this review
Types of studies
We included all randomized and quasi‐randomized controlled trials.
Types of participants
We included participants ventilated by one lung.
We included both surgical and intensive care participants.
We excluded participants who had only one lung (i.e. pneumonectomy or congenital absence of one lung).
Types of interventions
Maintenance of anaesthesia during one‐lung ventilation with inhalation anaesthesia (e.g. isoflurane, sevoflurane, desflurane) versus total intravenous anaesthesia (e.g. propofol).
Types of outcome measures
Primary outcomes
We measured the following primary outcomes:
Mortality rate (during the total observation period);
Adverse postoperative outcomes, such as brain damage, heart failure, myocardial infarction and blood transfusion (analysed separately); and
Intraoperative awareness (as subsequently reported by the participant).
Secondary outcomes
Our secondary outcomes were:
death at one month and six months;
abandonment of one‐lung technique;
length of stay in hospital; and
economic analysis (by narrative).
Search methods for identification of studies
We conducted systematic searches for randomized controlled trials. No language, publication year or publication status restrictions were applied. The date of the last search was February 2012.
Electronic searches
We searched the Cochrane Central Register of Controlled Trials (CENTRAL); The Cochrane Library (2012, Issue 11); MEDLINE (1966 to November 2012); Embase (1980 to November 2012); Literatura Latino‐Americana e do Caribe em Ciências da Saúde (LILACS, 1982 to November 2012) and ISI Web of Science (1945 to November 2012).
We reran the search in CENTRAL, MEDLINE, Embase, LILACS, and ISI web of Science on February 7, 2017 and found four potential studies of interest which have been added to a list of 'Studies Awaiting Classification' and will be incorporated into the formal review findings during the review update.
Please see Appendix 1 for our bibliographic search strategies.
Searching other resources
We searched the reference lists of identified relevant studies for additional citations; contacted specialists in the field and authors of the included trials for unpublished data and contacted pharmaceutical manufacturers to verify the data and obtain additional unpublished data.
Data collection and analysis
Selection of studies
Two review authors (NSPM and RPED) independently screened trials identified by the literature search, extracted the data, assessed trial quality and analysed the results. If consensus was not reached, we did not include the data from the trials in question unless and until the authors of those trials were able to resolve the contentious issues.
Data extraction and management
Two review authors (NSPM and RPED) independently extracted data. We resolved any discrepancies by discussion. We used a standard form (see Appendix 2) to extract the following information: characteristics of the study (design, methods of randomization); participants; interventions and outcomes (types of outcome measures, timing of outcomes, adverse events). Our data extraction form was based on recommendations made by the Cochrane Anaesthesia Review Group.
Assessment of risk of bias in included studies
We used the new risk of bias approach for Cochrane Reviews to assess study quality (Higgins 2011). Two review authors (NSPM and RPED) independently assessed the following six separate criteria. We resolved any discrepancies by discussion:
Adequate sequence generation;
Allocation concealment;
Blinding;
Incomplete outcome data;
Selective outcome reporting; and
Other sources of bias.
In the first step, we copied information relevant for making a judgement on a criterion from the original publication into an assessment table. If additional information was available from study authors, we entered this in the table along with an indication that this was unpublished information. Two review authors (NSPM and RPED) independently made a judgment as to whether the risk of bias for each criterion was considered to be 'low', 'uncertain' or 'high'. We resolved disagreements by discussion. We considered that trials categorized as 'low risk' for all six criteria were low bias‐risk trials.
Measures of treatment effect
Binary outcomes
For dichotomous data, we used the risk ratio (RR) as the effect measure with 95% confidence intervals (CIs).
Continuous outcomes
For continuous data, we presented the results as mean differences (MDs) with 95% CIs. When pooling data across studies, we estimated the MD if the outcomes were measured in the same way. We used the standardized mean difference (SMD) to combine trials that used different methods to measure the same outcome.
Unit of analysis issues
The unit of analysis was one outcome for each participant.
Dealing with missing data
We assumed that participants who dropped out were nonresponders.
Assessment of heterogeneity
We intended to quantify inconsistency among the pooled estimates using the I2 statistic. This illustrates the percentage of variability in effect estimates that results from heterogeneity rather than sampling error (Higgins 2003; Higgins 2011). We also intended to examine forest plots for CI overlap and to calculate the Chi2 test for homogeneity with a 10% level of significance. We used I2 statistical values to categorize heterogeneity: less than 25%; 25% to 50%; 50% to 75% and greater than 75%.
Assessment of reporting biases
Apart from assessing the risk of selective outcome reporting considered under assessment of risk of bias in included studies, we intended to assess the effects of small studies by using funnel plots, when at least 10 trials were identified.
Data synthesis
We planned to use the fixed‐effect model to analyse data. If I2 was greater than 50%, we intended to use random‐effects models. We planned to undertake quantitative analyses of outcomes on an intention‐to‐treat basis.
Subgroup analysis and investigation of heterogeneity
We planned the following subgroup analyses: different intravenous anaesthetics; different dosages of intravenous anaesthetics; different combinations of anaesthetics; different patient positions (e.g. lateral, supine) and different durations of anaesthesia (e.g. 20, 30 or 45 minutes). We also planned to perform subgroup analyses for different inhalation anaesthetics; different types of surgery (e.g. open thoracotomy, thoracoscopic); different criteria and diagnoses for admission to critical care units and the different units involved. Finally, we planned to perform subgroup analyses for studies of participants in intensive care compared with studies of participants undergoing surgery and for the criteria used to diagnose adverse events. However, the number of studies was insufficient for performance of any of these subgroup analyses.
Sensitivity analysis
We planned to perform sensitivity analyses to explore the causes of heterogeneity and the robustness of the results by means of the following factors:
Trials with low risk of bias versus those with high risk of bias; and
Rates of withdrawal for each outcome (< 20% vs greater than and/or equal to 20%).
However, the planned analyses could not be carried out because of lack of relevant data in the included studies.
Results
Description of studies
See the 'Characteristics of included studies' table.
Results of the search
We identified 2099 citations from the database searches (see Figure 1 for search results). After screening by title and abstract, we obtained full‐paper copies for 46 citations that were potentially eligible for inclusion in the review. Of these, 36 did not fulfil our inclusion criteria and were excluded for the reasons described in the 'Characteristics of excluded studies' table (see Figure 1). For the first update of the review in 2012, 705 references (post de‐duplication) were identified by the searches. We selected 12 references for careful reading and obtained them in full text when available. After assessing the full articles, we included 11 studies (De Conno 2009; Egawa 2009; Fukuoka 2009; Huang 2008; Iwata 2008; Pruszkowski 2007; Rutkowska 2009; Schilling 2011; Schwarzkopf 2009; Steurer 2007; Yamada 2008) and added one study (Celik 2009) to the exclusion table.
1.
Study flow diagram for the original review published in Issue 2, 2008 (Bassi 2008).
We reran the search on February 7, 2017. The new search identified 1093 citations, and there were four potential included studies (Erturk 2014; Hammouda 2013; Potočnik 2014; Wakabayashi 2014). We will deal with the pending studies of interest when we update the review. Potential new studies of interest were added to a list of 'Studies awaiting classification' and will be incorporated into the formal review findings during the review update.
See Figure 2
2.
Study flow diagram for the update published in 2013 and the updated search in 2017
Included studies
We included 20 studies (Abay 2000; Beck 2001; De Conno 2009; Egawa 2009; El‐Hakeem 2003; Fukuoka 2009; Gasowska 1999; Huang 2008; Iwata 2008; Kellow 1995; Pilotti 1999; Pruszkowski 2007; Rees 1984; Reid 1996; Rutkowska 2009; Schilling 2011; Schwarzkopf 2009; Spies 1991; Steurer 2007; Yamada 2008) in this review. These studies enrolled a total of 850 participants (please see the 'Characteristics of included studies' table).
Design of the studies
All included studies claimed to be randomized controlled trials.
Types of study participants
Abay 2000; Gasowska 1999 and Yamada 2008 included healthy participants with American Society of Anesthesiology (ASA) physical status one and two (ASA I and II) who were scheduled for thoracotomy, video‐assisted thoracoscopic surgery (inside the right hemithorax) and lobectomy, respectively. Pilotti 1999 and Spies 1991 included less healthy participants (ASA III). De Conno 2009 evaluated adults with ASA status I to III scheduled to undergo elective thoracic surgery with lung resection performed through thoracotomy or thoracoscopy. Egawa 2009 did not specify ASA status, but this study assessed participants scheduled for elective lung surgery in the lateral position. Fukuoka 2009 included participants with ASA status I and II requiring OLV during anaesthesia for selective thoracic surgery. Huang 2008 included participants with ASA physical status I and II between 20 and 60 years of age scheduled to undergo thoracoscopic surgery or oesophageal surgery, with limited lung trauma but lengthy OLV. Iwata 2008 assessed only participants scheduled for elective thoracic procedures in the lateral position. Pruszkowski 2007 assessed participants between 18 and 70 years of age who were undergoing lobectomy requiring OLV, with ASA I to III status. Rutkowska 2009 assessed participants with ASA grade I to III status for elective lobectomy. Schilling 2011 assessed participants scheduled for open thoracic surgery and OLV. In Schwarzkopf 2009, participants were included if ASA grade I to III and scheduled for thoracic surgery, with limited lung trauma but lengthy OLV. The other studies did not report ASA physical status but included participants scheduled for various thoracic operations (Beck 2001; El‐Hakeem 2003; Kellow 1995; Reid 1996), major thoracic surgery (Steurer 2007) and elective lung resection for carcinoma (Rees 1984).
Types of intervention
Studies compared one or more inhalation anaesthetics (sevoflurane, desflurane, isoflurane, halothane, enflurane) with one of three intravenous anaesthetics (propofol, ketamine, thiopental) for maintaining anaesthesia during one‐lung ventilation. Most studies used one of these intravenous drugs (or etomidate) to induce anaesthesia in all participants, including those in whom inhalation agents were used to maintain anaesthesia.
Types of outcome measures and duration of follow‐up
Studies reported a range of intraoperative physiological measurements, including haemodynamic and blood gas variables, as well as concentrations of inflammatory mediators.
De Conno 2009 also reported adverse events for five postoperative days. Egawa 2009 reported postoperative cognitive function.
Awaiting assessment
Egawa 2009 is an ongoing trial, and we will include its final analysis in the next update of this review.
Excluded studies
We excluded 37 studies; see the 'Characteristics of excluded studies' table for full details.
Studies awaiting classification
We reran the search in February 2017 and found four potential studies of interest. There are four studies awaiting classification (Erturk 2014; Hammouda 2013; Potočnik 2014; Wakabayashi 2014). These studies will be incorporated into the formal review findings during the review update. For further details of the studies see the table Studies awaiting classification.
Risk of bias in included studies
3.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Allocation
Eleven studies (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Kellow 1995; Pilotti 1999; Rutkowska 2009; Schwarzkopf 2009; Spies 1991; Steurer 2007; Yamada 2008) did not describe the procedures for random group allocation and allocation concealment.
Huang 2008 used a random table for allocation, and another anaesthesiologist, who was not involved with the study, performed the allocation concealment.
Egawa 2009 used a computer‐generated sequence and envelopes to conceal the sequence.
Two studies (De Conno 2009; Fukuoka 2009) performed a block randomization, generated by computer, and the sequence was concealed by sealed opaque envelopes.
Three studies (Iwata 2008;Rees 1984; Reid 1996) reported only the generation of the allocation sequence (computer‐generated random numbers) but did not describe the method used to conceal the sequence.
Pruszkowski 2007 used a computer‐generated randomization list, but the authors did not conceal the sequence.
Schilling 2011 used a computer‐generated random sequence, and the randomization list was password‐protected and concealed in white sealed envelopes.
Blinding
Thirteen studies (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Iwata 2008; Pilotti 1999; Rees 1984; Reid 1996; Rutkowska 2009; Schwarzkopf 2009; Spies 1991; Steurer 2007; Yamada 2008) did not describe whether participants, personnel or assessors of outcomes were blinded to treatment allocation.
Although the De Conno 2009 study did not report in the article whether there was blinding, this item was retrieved when the authors confirmed by email that only the assessors were blinded. This study did not report on the blinding of participants and personnel.
The Egawa 2009 study reported that participants and assessors were blinded, but investigators were not.
In two studies (Fukuoka 2009; Huang 2008), the anaesthesiologist who assessed the study data was blinded to the group assignments, but the studies did not report on blinding of participants and personnel. Participants from Huang 2008 were also blinded to treatment allocation.
In two studies (Kellow 1995; Pruszkowski 2007), all measurements were made by the same observer, who was not blinded to the anaesthetic regimen used. The authors did not discuss blinding of participants and personnel.
Schilling 2011 reported that participants were blinded, but anaesthesiologists who provided the anaesthetic were not. However, the individuals who performed the immunological and pathohistological analyses were blinded to the study protocol.
Incomplete outcome data
Nine studies (Abay 2000; Beck 2001; De Conno 2009; Fukuoka 2009; Kellow 1995; Pruszkowski 2007; Rees 1984; Reid 1996; Schwarzkopf 2009) reported the number of withdrawals or dropouts.
In Abay 2000, all participants completed the follow‐up. Beck 2001 excluded one participant from each group because of hypotension that was treated with vasoactive drugs during induction of anaesthesia. De Conno 2009 reported 10 and six dropouts with sevoflurane and propofol, respectively. Fukuoka 2009 excluded four participants because of re‐inflation of the nondependent lung. No drop‐outs were reported in Huang 2008. Kellow 1995 excluded one participant in the isoflurane group because of oxygen desaturation that did not resolve when the inspired oxygen concentration was increased. Pruszkowski 2007 excluded 15 participants: eight and seven in the propofol and sevoflurane groups, respectively. Rees 1984 excluded three participants because the duration of OLV was too short for sufficient data to be gathered. Reid 1996 excluded 10 participants: three because oxygen saturation fell below 90% and seven because surgery required ventilation to both lungs. In Schwarzkopf 2009, two and four participants were withdrawn in the sevoflurane and propofol groups, respectively.
In Schilling 2011, reporting was complete.
Egawa 2009 is an ongoing study: so far, less than 10% of participants have been excluded.
The other eight studies did not report withdrawals and drop‐outs (El‐Hakeem 2003; Gasowska 1999; Iwata 2008; Pilotti 1999; Rutkowska 2009; Spies 1991; Steurer 2007; Yamada 2008).
Selective reporting
No evidence of selective reporting was noted in the following included studies (Beck 2001; De Conno 2009; El‐Hakeem 2003; Fukuoka 2009; Gasowska 1999; Huang 2008; Iwata 2008; Kellow 1995; Pilotti 1999; Pruszkowski 2007; Rees 1984; Reid 1996; Schilling 2011; Schwarzkopf 2009; Spies 1991; Yamada 2008). We could not determine whether selective reporting occurred in Abay 2000; Egawa 2009; Rutkowska 2009; and Steurer 2007.
Other potential sources of bias
No evidence of other biases was found in any of the included studies.
Effects of interventions
See: Table 1
With the exception of Rees 1984, who reported results from oxygen delivery, all other studies included in the original review (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Kellow 1995; Pilotti 1999; Reid 1996; Spies 1991) did not report on any of the outcomes listed in the protocol. Hence it was not possible to carry out a meta‐analysis of studies from the original review. However, the new trials (De Conno 2009; Egawa 2009; Huang 2008; Iwata 2008; Pruszkowski 2007) reported on adverse postoperative outcomes and death.
Propofol versus sevoflurane
No differences in rates of postoperative adverse events were reported by two studies (De Conno 2009; Egawa 2009).
De Conno 2009 reported no deaths one month after surgery (0/27 and 0/27).
Propofol versus isoflurane
No adverse postoperative outcomes were described in Huang 2008 (0/15 and 0/15).
Discussion
Summary of main results
This review examined the effectiveness and safety of intravenous versus inhalation anaesthesia for one‐lung ventilation. We included 20 studies with a total of 850 participants and a mean of 42 participants per study (range 18 to 80), although most of the included studies evaluated between 30 and 40 participants. We did not find any randomized controlled trial that reported on participant outcomes. The quality of the included studies was very poor; as a result, it was not possible to use analytical methods such as meta‐analysis and exploration of heterogeneity (Table 1).
Overall completeness and applicability of evidence
Because of our comprehensive search strategy and contact with experts in the field, we are confident that we have mapped most clinical trials comparing inhalation with intravenous drugs to maintain anaesthesia during one‐lung ventilation.
Quality of the evidence
The methodological quality of the included studies was generally unclear (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Iwata 2008; Kellow 1995; Pilotti 1999; Rees 1984; Reid 1996; Rutkowska 2009; Schwarzkopf 2009; Spies 1991; Steurer 2007; Yamada 2008). Six studies were categorized as having low risk of bias (De Conno 2009; Egawa 2009; Fukuoka 2009; Huang 2008; Pruszkowski 2007; Schilling 2011). Methodological aspects of four studies had a high risk of introducing bias: incomplete outcome data (De Conno 2009; Reid 1996); poor allocation concealment (Pruszkowski 2007) and inadequate blinding of outcome assessment (Kellow 1995; Pruszkowski 2007).
Potential biases in the review process
A comprehensive search strategy was applied to identify all potential studies and their reports. However, although we emailed the first author of 9 studies (De Conno 2009; Egawa 2009; Fukuoka 2009; Huang 2008; Iwata 2008; Pruszkowski 2007; Rutkowska 2009; Schilling 2011; Schwarzkopf 2009) to ask for clarification about methodological issues and to provide us with further information, only six (De Conno 2009; Egawa 2009; Fukuoka 2009; Huang 2008; Pruszkowski 2007; Schilling 2011) responded.
Agreements and disagreements with other studies or reviews
No systematic review has compared the results of intravenous versus inhalation anaesthesia for participants undergoing OLV.
Zeng 2010 conducted a systematic review to evaluate the effects of thoracic epidural anaesthesia combined with general anaesthesia on arterial oxygenation and intrapulmonary shunting during one‐lung ventilation. However, no abstract was available. We have contacted the authors to request the full‐text article.
A systematic review that focused on postoperative recovery and complications found that early recovery was faster in the desflurane and sevoflurane groups in adult participants, although the authors included only English studies published in the MEDLINE database (Gupta 2004).
Ozkose 2001 performed an economic evaluation to assess sevoflurane and isoflurane anaesthesia on recovery and cost analyses after laminectomy and discectomy. The authors found that total intravenous anaesthesia was associated with highest intraoperative cost, faster recovery and the least frequent postoperative side effects.
Authors' conclusions
Implications for practice.
Very little evidence is available from randomized controlled trials to show differences in participant outcomes for anaesthesia maintained by intravenous versus inhalation anaesthesia during one‐lung ventilation.
Implications for research.
Further research should be carried out only if participant outcomes are measured, including deaths and morbidity such as brain damage, heart failure, myocardial infarction, intraoperative awareness and requirement for blood transfusion.
What's new
| Date | Event | Description |
|---|---|---|
| 14 February 2017 | Amended | New search run to February 2017, four new studies not fully incorporated and awaiting classification |
History
Protocol first published: Issue 1, 2007 Review first published: Issue 2, 2008
| Date | Event | Description |
|---|---|---|
| 12 November 2013 | Amended | Contact details updated |
| 4 July 2013 | New search has been performed | In the previous version (Bassi 2008), the databases were searched until 2006. We reran the searches until November 2012. We have included risk of bias, summary of finding tables and a new study flow diagram. |
| 4 July 2013 | New citation required but conclusions have not changed | This review is an update of the previous Cochrane systematic review (Bassi 2008) that included nine RCTs (Abay 2000; Beck 2001; El‐Hakeem 2003; Gasowska 1999; Kellow 1995; Pilotti 1999; Rees 1984; Reid 1996; Spies 1991) and enrolled 291 participants. The previous authors Adriana Bassi, Wilson RO Milani and Delcio Matos decided not to update the review (new authors: Norma SP Módolo, Marília P Módolo, Marcos A Marton, Enilze Volpato, Vinícius M Arantes and Regina P El Dib have updated this version). We found 11 new trials (De Conno 2009; Egawa 2009; Fukuoka 2009; Huang 2008; Iwata 2008; Pruszkowski 2007; Rutkowska 2009; Schilling 2011; Schwarzkopf 2009; Steurer 2007; Yamada 2008) that met our inclusion criteria. In general, our review reaches the same conclusions as the original review (Bassi 2008). However, we included more trials, and thus have the opportunity to plot the new trials on the following outcomes: intraoperative awareness and adverse postoperative outcomes. |
| 2 January 2008 | Amended | Converted to the new review format. |
Acknowledgements
We would like to thank John Carlisle (content editor); Nathan Pace (statistical editor) and Marjolein de Wit, Kristin B Miller, Marialena Trivelli and Maurizio Solca (peer reviewers); as well as Laszlo L Szegedi, Durhane Wong‐Rieger, Anne Lyddiatt, Karen Hovhannisyan, Jant Wale (consumer editor), and Jane Cracknell for their help and editorial advice during preparation of the 2008 review (Bassi 2008) and of the first update of this review. We would also like to thank Thomas Schilling (Schilling 2011), Junji Egawa (Egawa 2009) and the authors of the De Conno 2009; Fukuoka 2009; Huang 2008; and Pruszkowski 2007 studies for their responses during the preparation of the first published review, as well as Mina Nishimori for translation and extraction data from the Yamada 2008 study. We also would like to thank Adriana Bassi, Wilson RO Milani and Delcio Matos for their contributions to the first version of the review.
Appendices
Appendix 1. Search strategy
CENTRAL, The Cochrane Library
#1 OLV or one lung* or one‐lung* or single‐lung* or single lung or ((one lung*) near ventil*) #2 anesth* or anaesth* or propofol* or diisopropylphenol or diprivan* or disoprivan or disoprofol or pofol or sevofluran* or sevorane orultane or desfluran* or suprane or isofluran* #3 MeSH descriptor Anesthesia and Analgesia explode all trees #4 MeSH descriptor Anesthesia explode all trees #5 MeSH descriptor Anesthesia, Conduction explode all trees #6 MeSH descriptor Anesthesia, Inhalation explode all trees #7 MeSH descriptor Anesthesia, Closed‐Circuit explode all trees #8 MeSH descriptor Anesthesia, Intravenous explode all trees #9 MeSH descriptor Anesthetics, Intravenous explode all trees #10 MeSH descriptor Anesthetics, Dissociative explode all trees #11 MeSH descriptor Anesthetics, Inhalation explode all trees #12 (#2 OR #3 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11) #13 (#1 AND #12)
MEDLINE (Ovid SP)
1. (OLV or one?lung* or single?lung*).ti,ab. or ((one?lung* or single?lung*) adj3 ventil*).af. 2 . an?esth*.ti,ab. or (propofol* or diisopropylphenol or diprivan* or disoprivan or disoprofol or pofol or sevofluran* or sevorane or ultane or desfluran* or suprane or isofluran*).mp. or exp Propofol/ or explode Anesthetics‐Inhalation/ or explode Anesthetics‐Dissociative/ or explode Anesthetics‐Intravenous/ or explode Anesthesia‐Intravenous/ or explode Anesthesia‐Closed‐Circuit/ or explode Anesthesia‐Inhalation/ or explode Anesthesia‐Conduction/ or Anesthesia/ or explode Anesthesia‐and‐Analgesia/ 3. 1 and 2 4. ((randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or placebo.ab. or drug therapy.fs. or randomly.ab. or trial.ab. or groups.ab.) not (animals not (humans and animals)).sh. 5. 3 and 4
Embase (Ovid SP)
1. (OLV or one?lung* or single?lung*).ti,ab. or ((one?lung* or single?lung*) adj3 ventil*).af. (314) 2. an?esth*.ti,ab. or (propofol* or diisopropylphenol or diprivan* or disoprivan or disoprofol or pofol or sevofluran* or sevorane orultane or desfluran* or suprane or isofluran*).mp. or exp Propofol/ or anesthesia/ or analgesia/ or exp anesthesia‐induction/ or exp inhalation‐anesthesia/ or exp intravenous‐anesthesia/ or anesthetic‐agent/ (394435) 3. 1 and 2 (191) 4. (randomized‐controlled‐trial/ or randomization/ or controlled‐study/ or multicenter‐study/ or phase‐3‐clinical‐trial/ or phase‐4‐clinical‐trial/ or double‐blind‐procedure/ or single‐blind‐procedure/ or (random* or cross?over* or factorial* or placebo* or volunteer* or ((singl* or doubl* or trebl* or tripl*) adj3 (blind* or mask*))).ti,ab.) not (animals not (humans and animals)).sh. (4024409) 5. 3 and 4
ISI Web of Science
#1 TS=OLV OR TS=(single SAME lung) or TS=(one SAME lung) or TS=(lung SAME ventil*) #2 TS=anaest* or TS=anest* or TS=(Propofol* or diisopropylphenol or diprivan* or disoprivan or disoprofol or pofol or sevofluran* or sevorane or ultane or desfluran* or suprane or isofluran*) #3 TS=((SINGL* or DOUBL* or TREBL* or TRIPL*) SAME (BLIND* or MASK*)) or TS=(RANDOM* or TRIAL* or CROSSOVER* or CROSS‐OVER* or FACTORIAL* or PLACEBO* or VOLUNTEER*) or TS=(clinical SAME trial*) #4 #3 AND #2 AND #1
LILACS (BIREME)
"one" or "single" or "um" or "uno" or "solo" or "único" [Words] and "lung" or "pulmão" or "pulmón" [Words] and "ANESTHESIA" or "ANESTHESIA AND ANALGESIA" or "ANESTHESIA AND ANALGESIA/" or "ANESTHESIA, CLOSED‐CIRCUIT" or "ANESTHESIA, CLOSED‐CIRCUIT/" or "ANESTHESIA, CONDUCTION" or "ANESTHESIA, CONDUCTION/" or "ANESTHESIA, GENERAL/" or "ANESTHESIA, INHALATION" or "ANESTHESIA, INHALATION/" or "ANESTHETICS" or "ANESTHETICS, DISSOCIATIVE" or "ANESTHETICS, DISSOCIATIVE/" or "ANESTHETICS, GENERAL" or "ANESTHETICS, INHALATION" or "ANESTHETICS, INHALATION/" or "ANESTHETICS, INTRAVENOUS" or "ANESTHETICS, INTRAVENOUS/" or "Anestesia" or "Inhalation Do Anesthesia" or "Inhalación De la Anestesia" or "Conducción De la Anestesia" or "Condução Do Anesthesia" or "Intravenoso" or "Anestésicos" or "Anestésico" [Words]
Appendix 2. Data extraction form
| Review title or ID |
| Intravenous versus inhalation anaesthesia for one‐lung ventilation |
| Study ID(surname of first author and year first full report of study was published e.g. Smith 2001) |
| Report IDs of other reports of this study(e.g. duplicate publications, follow‐up studies) |
|
Notes: |
1. General information
| Date form completed(dd/mm/yyyy) | |
| Name/ID of person extracting data | |
|
Publication type (e.g. full report, abstract, letter) |
|
|
Possible conflicts of interest (for study authors) |
|
|
Notes: | |
2. Study eligibility
| Study Characteristics |
Eligibility criteria (insert eligibility criteria for each characteristic as defined in the Protocol) |
Yes | No | Unclear |
Location in text (pg & ¶/fig/table) |
|
| Type of study | Randomized controlled trial | |||||
| Quasi‐randomized trial | ||||||
|
Participants |
|
|||||
| Types of interventions | |
|||||
| Types of outcome measures | |
|||||
| INCLUDE | EXCLUDE | |||||
|
Reason for exclusion |
||||||
|
Notes: | ||||||
3. Population and setting
|
Description Include comparative information for each group (i.e. intervention and controls) if available |
Location in text (pg & ¶/fig/table) |
|
|
Population description Adults (> or equal to 18 years old) undergoing myocardial revascularization, regardless of gender, with or without extracorporeal circulation |
||
|
Setting (including location and social context) |
||
| Inclusion criteria | ||
| Exclusion criteria | ||
| Method/s of recruitment of participants | ||
|
Notes: | ||
4. Methods
|
Descriptions as stated in report/paper |
Location in text (pg & ¶/fig/table) |
|
|
Aim of study |
||
| Design(e.g. parallel, cross‐over, cluster) | ||
|
Unit of allocation The unit of analysis will be each participant recruited into the trials |
||
|
Period of study/recruitment |
|
|
|
Follow‐up |
||
|
Notes: | ||
5. Risk of bias assessment
| Domain |
Risk of bias |
Support for judgement |
Location in text (pg & ¶/fig/table) |
||
| Low risk | High risk | Unclear | |||
|
Random sequence generation (selection bias) |
|||||
|
Allocation concealment (selection bias) |
|||||
|
Blinding of participants and personnel (performance bias) |
Outcome group: all/ |
||||
| (if required) |
Outcome group: |
||||
|
Blinding of outcome assessment (detection bias) |
Outcome group: all/ |
||||
| (if required) |
Outcome group: |
||||
|
Incomplete outcome data (attrition bias) |
|||||
|
Selective outcome reporting? (reporting bias) |
|||||
|
Other bias |
|||||
|
Notes: | |||||
6. Participants
Provide overall data and, if available, comparative data for each intervention or comparison group.
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
|
|
Total no. randomized (or total pop. at start of study for NRCTs) |
||
|
Total no. analysed |
||
| Baseline imbalances | ||
|
Withdrawals and exclusions (if not provided below by outcome) |
||
| Age | ||
| Sex | ||
|
Comorbidities |
||
|
Other relevant sociodemographics |
||
|
Subgroups measured |
||
|
Subgroups reported |
||
|
Notes: | ||
7. Intervention groups
Copy and paste table for each intervention and comparison group.
Intervention Group 1: Intravenous anaesthesia
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
|
|
Group name |
||
|
No. randomized to group (specify whether no. people or clusters) |
||
|
Total no. analysed per group |
||
| Description(include sufficient detail for replication, e.g. content, dose, components) | ||
| Duration of treatment period | ||
| Timing(e.g. frequency, duration of each episode) | ||
|
Notes: | ||
Control group: Group 2: Inhalation anaesthesia
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
|
|
Group name |
||
|
No. randomly assigned to group (specify no. people or clusters) |
||
|
Total no. analysed per group |
||
| Description(include sufficient detail for replication, e.g. content, dose, components) | ||
| Duration of treatment period | ||
| Timing(e.g. frequency, duration of each episode) | ||
|
Notes: | ||
8. Outcomes
Outcome 1.1－Death (at one month)
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
Outcome 1.2－Mortality rate (at six months)
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
Outcome 2－Abandonment of one‐lung technique
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
Outcome 3－Length of stay in hospital
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
Outcome 4－Economic analysis (by narrative)
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
Outcome 5－Oxygen delivery and consumption
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
||
|
Outcome name |
|||
| Time points measured | |||
| Time points reported | |||
| Outcome definition(with diagnostic criteria if relevant) | |||
| Person measuring/reporting | |||
| Is outcome/tool validated? | Yes No Unclear |
||
| Imputation of missing data (e.g. assumptions made for ITT analysis) | |||
|
Assumed risk estimate (e.g. baseline or population risk noted in Background) |
|||
| Power | |||
|
Notes: | |||
9. Applicability
| Have important populations been excluded from the study?(consider disadvantaged populations and possible differences in the intervention effect) | Yes No Unclear |
|
| Is the intervention likely to be aimed at disadvantaged groups?(e.g. lower socioeconomic groups) | Yes No Unclear |
|
|
Does the study directly address the review question? (any issues of partial or indirect applicability) |
Yes No Unclear |
|
|
Notes: | ||
10. Other information
|
Description as stated in report/paper |
Location in text (pg & ¶/fig/table) |
|
|
Key conclusions of study authors |
||
|
References to other relevant studies |
||
| Correspondence required for further study information(from whom, what and when) | ||
|
Notes: | ||
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Abay 2000.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: before intubation and 20 min after the onset of one‐lung ventilation | |
| Participants | N: 20 participants. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: ASA I and II scheduled for thoracotomy. Exclusion criteria: not reported | |
| Interventions | Sevoflurane (2%) in group 1 versus propofol (1 mg/kg/h) and alfentanil (1.5 µg/kg/min) in group 2 | |
| Outcomes | Haemodynamic measurement and blood gas values | |
| Notes | Anaesthesia was induced with propofol in all participants | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | All participants completed the study |
| Selective reporting (reporting bias) | Unclear risk | Not reported (abstract) |
| Other bias | Unclear risk | Not reported |
Beck 2001.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: reported. Follow‐up: after 30 min of TLV in the supine position; after 30 min stable OLV in the supine position and after opening of the pleura in the lateral decubitus position and before surgical manipulation of the lung (OLV) | |
| Participants | N: 40 participants. Sex: group 1: 6 females and 13 males; group 2: 7 females and 12 males. Age, y (mean): sevoflurane group 58 and propofol group 62. Setting: not reported. Inclusion criteria: subjects requiring OLV for thoracic surgery. Exclusion criteria: not reported | |
| Interventions | Propofol was infused continuously at an initial rate of 9 mg/kg‐1/h‐1 reduced to 6 mg/kg‐1/h‐1 after 10 min and sevoflurane of 1.8 vol% (end‐expiratory concentration) | |
| Outcomes | Cardiac index, mean arterial pressure, mean pulmonary artery pressure and PaCO2 | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Two participants, one from each group, were excluded from analysis because vasoactive drugs were given for hypotensive episodes during anaesthetic induction |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
De Conno 2009.
| Methods | Design: RCT. Single‐centre. Period: not reported. Sample size: reported (40% difference in expression on inflammatory mediators at a 5% level of statistical significance and a power of 80%). Follow‐up: five days | |
| Participants | N: 70 randomly assigned, but 54 analysed. Sex: sevoflurane: 13 females and 14 males; propofol: 9 female and 18 males. Age, y (mean): sevoflurane group 55 and propofol group 58. Setting: not reported. Inclusion criteria: adults with ASA physical status I to III, scheduled to undergo elective thoracic surgery with lung resection performed through thoracotomy or thoracoscopy. Exclusion criteria: any dose of systemic or topical steroids, acute pulmonary or extrapulmonary infections, severe chronic obstructive pulmonary disease (Gold stage 2 to 4), history of recurrent pneumothoraces, pneumonectomy and/or lung volume‐reduction surgery | |
| Interventions | Propofol (2.0 to 4.0 mcg/mL) or sevoflurane (1 MAC) | |
| Outcomes | Inflammatory mediators in BALF; clinical postoperative outcomes (adverse events). Adverse events were defined as pulmonary infections necessitating antibiotic treatment; radiographically diagnosed pneumonia, atelectasis, effusion; fistula; reintubation; systemic inflammatory response syndrome; sepsis; acute respiratory distress syndrome; surgical revision and death | |
| Notes | Anaesthesia was induced with propofol in all participants. We contacted the authors of the study on 8 August 2011 to ask about the generation of allocation, allocation concealment and blind assessment procedures. Furthermore, we asked which exact target concentration of protocol participants received during anaesthesia maintenance. The authors replied on 21 September 2011 |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Assessors were blinded [information retrieved by email from the authors] |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The authors analysed in all participants the BALF outcome. Only in 27 participants (14 propofol, 13 sevoflurane) the investigators analysed all BALF, cells and blood |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Egawa 2009.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: participants started to be recruited in March 2007 (ongoing study) [information retrieved by email from the authors]. Sample size: calculated the sample size using STATATM, significance level of 5% and power of 80% [information retrieved by email from the authors]. Follow‐up: 15 min after the termination of OLV | |
| Participants | N: 60. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: participants ASA I to III scheduled for elective lung surgery in the lateral position. Exclusion criteria: pulmonary fibrosis or interstitial pulmonary disease; pregnant woman; mental disorder; MMSE score less than 24; moderate and severe liver dysfunction; moderate and severe renal dysfunction and blood coagulation abnormality [information retrieved by email from the authors] | |
| Interventions | Propofol (n = 30) versus sevoflurane (n = 30), both combined with fentanyl and epidural anaesthesia | |
| Outcomes | Regional cerebral oxygen saturation values, cognitive function | |
| Notes | Conference proceedings. We contacted the main author on 13 November 2011 to ask about the full text. Egawa 2009 informed us, the day after we emailed them, that the study is ongoing, so we sent another email to ask for further information about the study. The author replied on 16, 23 and 25 November, 2011 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated [information retrieved by email from the authors] |
| Allocation concealment (selection bias) | Low risk | Envelopes [information retrieved by email from the authors] |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Participants are blinded, but anaesthesiologists are not blinded to treatment allocation [information retrieved by email from the authors] |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Yes [information retrieved by email from the authors] |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Few drop‐outs so far, <10% according to information retrieved by email from the authors |
| Selective reporting (reporting bias) | Unclear risk | Not reported (abstract) |
| Other bias | Low risk | No conflict of interest |
El‐Hakeem 2003.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: after 30 min of TLV; after 30 min of OLV in supine position and during OLV in the lateral position with the chest open and before surgical manipulation of the lungs | |
| Participants | N: 30. Sex: sevoflurane group: 6 males and 9 females; propofol group: 7 males and 8 females. Age, y (mean): sevoflurane group 50.7, propofol group 48.0. Setting: not reported. Inclusion criteria: participants requiring OLV for thoracic surgery. Exclusion criteria: not reported | |
| Interventions | Sevoflurane (1 MAC; n = 15) versus propofol (4 to 6 mg/kg/h; n = 15) | |
| Outcomes | Haemodynamic variables, pulmonary shunt, mixed venous oxygen tension, arterial oxygen tension and arterial carbon dioxide tension | |
| Notes | All participants were premedicated with oral midazolam (0.1 mg/kg) one hour before surgery | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Fukuoka 2009.
| Methods | Design: RCT. Single‐centre. Period: not reported. Sample size: based on the PaO2 values measured in a previous study. Follow‐up: 45 minutes of OLV | |
| Participants | N: 36 randomly assigned and 32 considered on the final analysis. Sex: 11 male and 5 female in propofol group, 7 male and 9 female in sevoflurane group. Age, y (mean): 67 in both groups. Setting: a university hospital. Inclusion criteria: participants with ASA status I and II requiring OLV during anaesthesia for selective thoracic surgery. Exclusion criteria: patients with severe cardiovascular or respiratory disease, morbid obesity (body mass index > 30) or ASA physical status 3 or 4 | |
| Interventions | Propofol (3 to 5 mg/kg/h) versus sevoflurane (1.4% to 1.6%) | |
| Outcomes | Relationship between the initial ETCO2 difference and the lowest PaO2 value recorded during the first 45 minutes of OLV | |
| Notes | We contacted the authors of the study by email on 21 July 2011 to ask whether the participants from the Iwata 2008 study were the same as those in their clinical trial. Fukuoka 2009 replied to the email on 26 July 2011, saying that "...the patients from both publications are not the same". We resent an email to ask if perhaps some of the participants were the same as in the Iwata 2008 study and to clarify whether participants and personnel were blinded to treatment allocation. The authors confirmed that participants from the two publications are not the same | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated codes |
| Allocation concealment (selection bias) | Low risk | Sealed and opaque envelopes |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | The anaesthesiologist who assessed the study data were blinded to group assignments |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Only four participants were lost (these participants were excluded because of re‐inflation of the nondependent lung) |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Low risk | No evidence |
Gasowska 1999.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: 10 min after induction of anaesthesia, when the participant was in the supine position and both lungs were ventilated; 10 min after a position shift (left lateral); 10 min of left OLV; 20 min of left OLV; 10 min ventilation of both lungs in the lateral position | |
| Participants | N: 47. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: participants with ASA grades I and II, admitted for right‐sided diagnostic or therapeutic elective VATS procedures. Exclusion criteria: patients with oxygen haemoglobin saturation < 97% were immediately (preoperatively) excluded from the study | |
| Interventions | Halothane (0.4% to 0.6%), isoflurane (0.5% to 1.0%) or propofol (10‐8‐6 mg/kg/h) | |
| Outcomes | VATS procedures: resection of emphysematous bullae, lung biopsy, biopsy of a peripheral lung nodule, dissection of adhesions, resection of a pericardial cyst. Blood gas values, alveolar‐arterial differences of oxygen partial pressure and Qs/Qt | |
| Notes | The halothane and isoflurane groups also received nitrous oxide, whilst the propofol group received air | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Huang 2008.
| Methods | Design: RCT. Single‐centre. Period: from August 2003 to July 2004 [information retrieved by email from the authors]. Sample size: 80% of power, 0.05 alpha, analysed by statistics specialist from their hospital [information retrieved by email from the authors]. Follow‐up: only during the intraoperative period (T1: the first 2LV just before performing OLV; T2: near the end of OLV just before resuming 2LV, mostly 30 to 45 minutes after OLV; T3: 5 minutes after resuming 2LV and T4: 20 min after resuming 2LV) | |
| Participants | N: 30. Sex: 19 men and 11 women. Age, y (mean): propofol 44 and isoflurane 40. Setting: Taiwan University Hospital. Inclusion criteria: participants with ASA physical status I and II, 20 to 60 years of age, scheduled to undergo thoracoscopic surgery or oesophageal surgery, with limited lung trauma but lengthy OLV. Exclusion criteria: reoperation, steroid use, and antioxidant or immunosuppressant usage [information retrieved by email from the authors] | |
| Interventions | Propofol (started at 10 mg/kg/h for 10 min and then switched to 8 mg/kg/h throughout the study; n = 15) versus isoflurane (1% to 2%; n = 15) | |
| Outcomes | Haemodynamic data; reactive oxygen species (ROS) production and total antioxidant status (TAS) | |
| Notes | We contacted the authors of the study on 13 November 2011 to ask about the following:
The authors replied on 16 November, 2011. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random table [information retrieved by email from the authors] |
| Allocation concealment (selection bias) | Low risk | By another anaesthesiologist who was not involved in the study [information retrieved by email from the authors] |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Participants were blinded, but the anaesthesiologist was aware of the study objectives [information retrieved by email from the authors] |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Investigators responsible for analyses of ROC production and TAS level were blinded to the anaesthetic technique |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | No drop‐outs [information retrieved by email from the authors] |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Low risk | None of the authors had conflicts of interest [information retrieved by email from the authors] |
Iwata 2008.
| Methods | Design: RCT. Single‐centre. Period: not reported. Sample size: based on the formula for normal distribution and assuming a type I error of 0.05 and a power of 0.95. Follow‐up: 15 min after the termination of OLV | |
| Participants | N: 52. Sex: 16 male and 10 female in propofol group; 17 male and 9 female in sevoflurane group. Age, y (mean): 61 in propofol group and 63 in sevoflurane group. Setting: university hospital. Inclusion criteria: participants scheduled for elective thoracic procedures in the lateral position. Exclusion criteria: renal insufficiency, liver dysfunction, cerebral infarction, documented coagulopathy or coronary or vascular disease | |
| Interventions | Sevoflurane versus propofol combined with epidural anaesthesia | |
| Outcomes | Haemodynamic variables, SpO2 and blood gas analyses | |
| Notes | We contacted the authors of the study on 27 September 2011 to ask about the period of the study, the generation of allocation, allocation concealment and blind assessment of outcomes. Furthermore, we have asked whether this study evaluated the same participants as were included in Fukuoka 2009. We are awaiting their reply | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random numbers |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Kellow 1995.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: TLV, after 20 min of the allocated maintenance regimen during TLV; OLV, after 20 min of stable OLV before ligation or division of any pulmonary vessels or bronchi; end, during wound closure after at least 20 min of stable ventilation of all remaining lung tissue | |
| Participants | N: 22 (10 isoflurane group and 12 propofol group). Sex: isoflurane group: 3 female and 7 male; propofol group－2 female and 10 male. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: participants undergoing elective thoracotomy requiring OLV. Exclusion criteria: patients were excluded if they were younger than 18 or older than 75 years old, and if their cardiac rhythm was not predominantly sinus | |
| Interventions | Isoflurane (1% to 1.5%) versus propofol (10 mg/kg/h, reducing at 10 min intervals to 8 and then 6 mg/kg/h) | |
| Outcomes | Cardiac index, heart rate, mean arterial pressure, pulmonary vascular resistance index, right ventricular ejection fraction, end‐systolic and end‐diastolic volume indices, shunt fraction and changes in haemodynamic data | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | After induction, all measurements were made by the same observer, who was not blinded to the anaesthetic regimen used |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | One participant in the isoflurane group was eliminated from the study after arterial desaturation that did not respond to increasing concentration of inspired oxygen |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Pilotti 1999.
| Methods | Design: RCT. Single‐centre. Sample size: not reported. Follow‐up: not reported | |
| Participants | N: 50. Sex: 43 female and 7 male. Age, y (mean): 63.8. Inclusion criteria: ASA II and III. Exclusion criteria: not reported | |
| Interventions | Group A propofol (4 to 7 mg/kg/h), fentanyl (1.5 to 2 µg/kg/h), atracurium (0.5 mg/kg/h) versus group B isoflurane (0.7% to 1.2%), fentanyl (1.2 to 1.5 µg/kg/h), atracurium (0.5 mg/kg/h) | |
| Outcomes | Pressure values, heart rate, PaO2 and PaCO2 levels, SPO2 and PECO2 | |
| Notes | Premedication with diazepam 10 mg plus atropine 0.5 mg | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Pruszkowski 2007.
| Methods | Design: RCT. Multicentre. Period: author could not provide the period of the study [information retrieved by email contact with the authors]. Sample size: two‐tailed, alpha error of 5% and beta error of 20%. Follow‐up: 40 min after initiation | |
| Participants | N: 80 randomly assigned and 65 completed the study. Sex: sevoflurane, 7 female and 26 male; propofol, 7 female and 25 male. Age, y (mean): 62 and 57, respectively, sevoflurane and propofol. Inclusion criteria: participants undergoing lobectomy requiring OLV, age between 18 and 70 years of age, ASA I to III and indication for thoracic epidural anaesthesia. Exclusion criteria: patients taking vasoactive drug at the time of selection | |
| Interventions | Propofol versus sevoflurane | |
| Outcomes | The primary outcome was defined as the lowest PaO2 during the study period. Other outcomes were measured: arterial blood gas analysis, end‐tidal carbon dioxide concentration, heart rate, mean arterial pressure and BIS value | |
| Notes | We contacted the authors of the study on 5 October 2011 to ask about the period of study, allocation concealment and blind assessment of outcome. The authors replied on the same day, saying that neither outcome assessment nor allocation was concealed. With regard to the period of the study, the authors could not provide this information | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomization list |
| Allocation concealment (selection bias) | High risk | No protection [information retrieved by email from the authors] |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No blinding [information retrieved by email from the authors] |
| Incomplete outcome data (attrition bias) All outcomes | High risk | 15 participants were lost: 20% and 17.5%, respectively, propofol and sevoflurane |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Rees 1984.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: 5, 15, 30 and 45 min after establishment of OLV and again 15 min after re‐establishment of two‐lung ventilation | |
| Participants | N: 24 men. Age, y (mean): group one 55 and group two 60. Setting: not reported. Inclusion criteria: elective lung resections for carcinoma. Exclusion criteria: not reported | |
| Interventions | Ketamine 2 mg/kg followed by 0.65 mg/kg of d‐tubocurare intravenously versus 1% to 3% enflurane | |
| Outcomes | Arterial blood samples, cardiac output, intrapulmonary shunt, cardiac index, oxygen delivery, oxygen consumption, stroke volume index, left and right ventricular stroke work indices, pulmonary vascular resistance and systemic vascular resistance | |
| Notes | All participants were given 10 mg of diazepam and 5 mg of droperidol intravenously before monitoring lines were inserted. The groups received different induction drugs (ketamine and thiopental) and different maintenance drugs (ketamine at 2 mg/kg/h vs enflurane 1% to 3%) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomization schedule |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Three participants were removed from the study because of the shortness of the period of OLV and hence failure to gather sufficient data (12.5%) |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Reid 1996.
| Methods | Design: RCT. Single‐centre: tertiary care university hospital. Period: not reported. Sample size: not reported. Follow‐up: during two‐lung ventilation and after 20 and 30 minutes of OLV with each anaesthetic technique | |
| Participants | N: 30. Sex: not reported. Age, y (mean): for all participants 59. Setting: tertiary care university hospital. Inclusion criteria: participants undergoing thoracoscopic pulmonary surgery or oesophageal surgery. Exclusion criteria: not reported | |
| Interventions | Participants received either propofol‐alfentanil infusion anaesthesia or one minimum alveolar concentration (MAC) of isoflurane during the initial period of two‐lung ventilation and the first 30 minutes of OLV and then were switched to the other anaesthetic for the duration of OLV | |
| Outcomes | Arterial blood gases and haemodynamic variables | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | By lottery |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | High risk | 10 participants; in 3, the study protocol was terminated prematurely because of arterial oxygen desaturation < 90%; in the other 7, the protocol was terminated because re‐inflation of the nonventilated lung was required for surgical reasons before the study protocol could be completed |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Rutkowska 2009.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: 30 min after start of OLV | |
| Participants | N: 40. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: participants with ASA physical status I to III scheduled for elective lobectomy. Exclusion criteria: not reported | |
| Interventions | Propofol (n = 20) versus desflurane (n = 20) combined with thoracic anaesthesia | |
| Outcomes | Haemodynamic and respiratory parameters, stroke volume and cardiac index | |
| Notes | Conference proceedings. We contacted the main author on 5 October 2011 to ask about the full text. We are awaiting the reply | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Not reported (abstract) |
| Other bias | Unclear risk | No evidence |
Schilling 2011.
| Methods | Design: RCT. Single‐centre. Period: November 2006 to June 2008 [information retrieved by email from the authors]. Sample size: reported; on the basis of previous studies, significance level of 5% and power of 80%. Follow‐up: 30 min after the surgical procedure | |
| Participants | N: 63. Sex: 41 male and 22 female. Age, y (mean): 64 for propofol group, 60 for desflurane group and 63 for sevoflurane group. Setting: Otto‐von‐Guericke‐Universty Magdeburg. Inclusion criteria: participants scheduled for open thoracic surgery and OLV. Exclusion criteria: persistent tobacco abuse, body mass index greater than 35 kg/m2, history of treatment with immunodepressant drugs in the 6 weeks before surgery, cardiac failure (New York Heart Association greater than II), clinically relevant obstructive or restrictive lung disease (vital capacity or forced expiratory volume in 1 s < 50% of predicted value), pulmonary hypertension (mean pulmonary arterial pressure greater than 25 mm Hg) or preexisting coagulation disorders and participants with evidence of pulmonary or systemic infection | |
| Interventions | Propofol (4 mg/kg/h) or sevoflurane (1 MAC) | |
| Outcomes | Cytokine concentrations (concentrations of TNF‐a and IL‐1b, IL‐6, IL‐8, IL‐10 and IL‐12 p70 in bronchoalveolar lavage fluids and serum samples), ventilation and gas exchange data and haemodynamic data | |
| Notes | Anaesthesia was induced with propofol in all participants We contacted the authors of the study on 5 October 2011 to ask about the period of the study, allocation concealment and blind assessment of outcome. The authors answered our queries. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated software (i.e. randomization was done by EXCEL scripts, which deliver columns (according to the number of groups needed) of random numbers) [information retrieved by email from the authors] |
| Allocation concealment (selection bias) | Low risk | Randomization list was password‐protected and white sealed envelopes were used [information retrieved by email from the authors] |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants were blinded, but anaesthesiologists who provided the anaesthesia were not [information retrieved by email from the authors] |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | The persons who did the immunological/pathohistological analyses were blinded to the study protocol [information retrieved by email from the authors] |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | All enrolled participants completed the study successfully |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Schwarzkopf 2009.
| Methods | Design: RCT. Single‐centre. Period: not reported. Sample size: not reported. Follow‐up: 30 min after beginning of OLV | |
| Participants | N: 60 randomly assigned and 54 completed the study. Sex: sevoflurane male:female 19:9; propofol 16:10. Age, y (mean): sevoflurane 61 and propofol 57. Setting: University Hospital in Jena, Germany. Inclusion criteria: participants with ASA grade I to III scheduled for thoracic surgery, with limited lung trauma but lengthy OLV. Exclusion criteria: not reported | |
| Interventions | Propofol (range 3 to 6 mg/kg/h) versus sevoflurane (1 MAC) | |
| Outcomes | Arterial blood gases, haemodynamic and respiratory parameters | |
| Notes | In both groups, anaesthesia was induced with propofol. We contacted the authors of the study on 13 November 2011 to ask about the following:
We are awaiting the authors' reply. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | A total of 6.7% and 13.4% of withdrawals in sevoflurane and propofol, respectively |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Spies 1991.
| Methods | Design: RCT. Single‐centre or multicentre: not reported. Period: not reported. Sample size: not reported. Follow‐up: during TLV; 15 min after induction in the supine position; 20 min after surgical opening of the chest in the lateral decubitus position; 20 min after start of OLV and after extubation | |
| Participants | N: 28. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: ASA risk groups II and III. Exclusion criteria: not reported | |
| Interventions | Propofol (10 mg/kg/h) versus enflurane (1 MAC) | |
| Outcomes | Haemodynamics and arterial and mixed venous blood gases | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
Steurer 2007.
| Methods | Design: RCT. Multicentre or single‐centre: not reported. Period: not reported. Sample size: not reported. Follow‐up: not reported | |
| Participants | N: 18 randomly assigned. Sex: not reported. Age, y (mean): not reported. Setting: not reported. Inclusion criteria: participants undergoing major thoracic surgery. Exclusion criteria: not reported | |
| Interventions | Propofol (n = 9) versus sevoflurane (n = 9) | |
| Outcomes | Inflammatory mediators | |
| Notes | Conference proceedings. We contacted the main author on 13 November 2011 to ask about the full text. We are awaiting the reply | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Not reported (abstract) |
| Other bias | Unclear risk | Not reported |
Yamada 2008.
| Methods | Design: RCT. Multicentre or single‐centre: single‐centre. Period: February 2007 to February 2008. Sample size: not reported. Follow‐up: the end of surgery | |
| Participants | N: 50. Sex: propofol (14 males and 11 females); sevoflurane (10 males and 15 females). Age, y (mean): propofol 72.0 and sevoflurane 66.8. Setting: university hospital. Inclusion criteria: ASA I or II, diagnosed with lung tumour and scheduled for lung lobectomy requiring OLV. Exclusion criteria: patients with cerebrovascular disease; patients with impaired pulmonary function | |
| Interventions | Propofol (2 to 3 mcg/mL, n = 25) versus sevoflurane (1% to 2%, n = 25) | |
| Outcomes | Cerebral regional oxygen saturation during surgery; PaO2, PaCO2, HR, mean arterial pressure, arterial pressure‐based cardiac index, haemoglobin concentration, body temperature | |
| Notes | Article in Japanese, only the abstract was written in English. Mina Nishimori, a Cochrane review author, kindly translated and extracted data from the Yamada 2008 study | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | No withdrawals/drop‐outs |
| Selective reporting (reporting bias) | Low risk | No evidence |
| Other bias | Unclear risk | Not reported |
ASA = American Society of Anesthesiologists' grade; BALF = Bronchoalveolar lavage fluid; MAC = Minimum alveolar concentration; OLV = One‐lung ventilation; PaO2 = Arterial oxygen partial pressure; PaCO2 = Arterial carbon dioxide tension; PECO2 = End‐tidal carbon dioxide partial pressure; Qs/Qt = Shunt fraction; RCT = Randomized controlled trial; ROS = reactive oxygen species; TAS = total antioxidant status; TLV or 2LV = Two‐lung ventilation; T1 = Time 1; VATS = Video‐assisted thoracic surgery.
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
|---|---|
| Abe 1998a | Randomized controlled trial comparing isoflurane and sevoflurane |
| Abe 1998b | Randomized controlled trial comparing isoflurane and sevoflurane |
| Benumof 1987 | Randomized controlled trial comparing halothane and isoflurane |
| Boldt 1996 | Randomized controlled trial comparing intravenous anaesthetics |
| Bovill 1984 | Randomized controlled trial comparing intravenous anaesthetics |
| Canet 1994 | Randomized controlled trial comparing halothane and isoflurane |
| Carlsson 1987 | Case series evaluating isoflurane |
| Celik 2009 | Randomized controlled trial of desflurane versus sevoflurane |
| Cigarini 1990 | Randomized controlled trial comparing thiopental and propofol |
| Dikmen 2003 | Case series comparing inhalation anaesthetics |
| Dupont 1999 | Randomized cross‐over design comparing sevoflurane, desflurane and isoflurane |
| Furugen 1989 | Case series evaluating propofol |
| He 1996 | Randomized clinical trial evaluating sevoflurane |
| He 1999 | Evaluated only isoflurane and desflurane |
| Koishi 1998 | Retrospective study |
| Koishi 1999 | Retrospective study comparing intravenous anaesthetics |
| Ma 1998 | Randomized controlled trial comparing halothane and sevoflurane |
| Merli 1991 | Case series evaluating propofol |
| Pagel 1998 | Randomized controlled trial comparing isoflurane and desflurane |
| Pueyo 1994 | Case series evaluating propofol |
| Rogers 1985 | Randomized controlled trial comparing halothane and isoflurane |
| Rosso 1995 | Prospective study with propofol |
| Saito 2000 | Randomized cross‐over design comparing sevoflurane and isoflurane |
| Satoh 1998 | Case series evaluating isoflurane |
| Shimizu 1997 | Randomized controlled trial evaluating isoflurane and sevoflurane |
| Sjögren 1995 | Case series comparing inhalation anaesthetics |
| Slinger 1988 | Randomized controlled trial comparing enflurane and isoflurane |
| Slinger 1995 | Case series evaluating isoflurane |
| Solares 1992 | Case series evaluating isoflurane |
| Steegers 1990 | Case series evaluating intravenous anaesthetics |
| Temp 1992 | Case series evaluating isoflurane |
| Van Keer 1989 | Case series evaluating intravenous anaesthetics |
| Van Leeuwen 1990 | Randomized controlled trial evaluating intravenous anaesthetics |
| Wang 1998 | Randomized cross‐over design evaluating sevoflurane and isoflurane |
| Wang 2000 | Randomized prospective cross‐over study evaluating desflurane and isoflurane |
| Yamada 1990 | Controlled clinical trial |
| Yondov 1999 | Comparative controlled study |
Characteristics of studies awaiting assessment [ordered by study ID]
Erturk 2014.
| Methods | Design: RCT. Multicentre or single‐centre: single‐centre. Setting: not reported. Period: not reported. Sample size: not reported. Follow‐up: not reported |
| Participants | N: 44. Inclusion criteria: aged between 18 and 65, ASA physical status I or II, undergo‐ ing OLV/2LV for thoracic surgery. Exclusion criteria: patients with ASA score of III or more and severe metabolic, renal, or hepatic diseases, using cigarettes or antioxidant agents |
| Interventions | Sevoflurane versus propofol |
| Outcomes | Mean arterial pressures, heart rate, blood gas analyses |
| Notes |
Hammouda 2013.
| Methods | Design: RCT. Multicentre or single‐centre: single‐centre. Setting: Alexandria Main University Hospital. Period: not reported. Sample size: not reported. Follow‐up: 2nd postoperative day |
| Participants | N: 40. Inclusion criteria: patients schedule to elective lung resection surgery through thoracotomy. Exclusion criteria: acute pulmonary or extra pulmonary infections; severe chronic obstructive pulmonary diseases, and history of recurrent pneumothoraces; pneumonectomy and lung volume reduction surgery; contraindications for epidural catheter insertio; patients on chemotherapy, radiotherapy, immunosuppressant drugs or corticosteroids; history of allergy to local anaesthetic drugs; and trauma patients |
| Interventions | Sevoflurane versus propofol |
| Outcomes | Systemic inflammatory response, pulmonary inflammatory response, C‐reactive protein, leucocyte count, and recovery status |
| Notes |
Potočnik 2014.
| Methods | Design: RCT. Multicentre or single‐centre: single‐centre. Setting: University Medical Centre Ljubljana. Period: 2009‐2013. Sample size: significance level of 0.05 and a power of 80%, it was enough to have 16 patients in each group. Follow‐up: 6 hours after surgery |
| Participants | N: 40. Inclusion criteria: the study included patients aged 20‐70 years with the American Society of Anesthesiologists (ASA) physical status I‐III, scheduled for elective open lobectomy with OLV. Exclusion criteria: history of drug hypersensitivity, drug addiction, treatment with psychotropic drugs, severe psychiatric and central nerve system diseases, persistent tobacco abuse, autoimmune system diseases, diabetes mellitus, cardiac failure (New York Heart Association class greater than 2), clinically relevant obstructive and restrictive lung diseases (vital capacity or forced expiratory volume in 1 s lower than 50% of the predicted values), pulmonary hypertension (mean pulmonary arterial pres‐ sure greater than 25 mm Hg), pre‐existing coagulation disorders, and history of treatment with immunosuppressant drugs in the 4 weeks before surgery. Patients with evidence of pulmonary or systemic infections (CRP serum concentration greater than 5 mg/L, leucocytosis greater than 10.0 gigaparticles/L or body temperature greater than 37°C) were also excluded, as well as the patients who had received perioperative blood derivatives, steroids, or NSAIDs |
| Interventions | Sevoflurane versus propofol |
| Outcomes | Inflammatory mediators (interleukins 6, 8, and 10, C‐reactive protein [CRP], and pro‐calcitonin) and clinical postoperative outcome |
| Notes |
Wakabayashi 2014.
| Methods | Design: RCT. Multicentre or single‐centre: single‐centre. Setting: not reported. Period: not reported. Sample size: not reported. Follow‐up: not reported |
| Participants | N: 20. Inclusion criteria: American Society of Anesthesiologists Physical Status category I‐II, undergoing cervico‐thoraco‐abdominal three‐field lymph node dissection through a right thoracotomy. Exclusion criteria: neurologic or psychiatric disease, cardiac disease classified as NYHA classes II‐IV, preoperative severe impairment of respiratory function (such as a vital capacity of <50% or a forced expiratory volume in 1 sec of <50% of that predicted), and pre‐existing coagulopathy or thrombocytopenia. Subjects were also excluded if they exhibited systemic or local active infections (either clinically defined or evidenced by elevated C‐reactive protein levels, leukocytosis or body temperature of >38̊C) |
| Interventions | Sevoflurane versus propofol |
| Outcomes | Inflammatory cytokines and chemokine [tumour necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, IL‐8, IL‐10 and IL‐12p70] |
| Notes |
Differences between protocol and review
The assessment of risk of bias in included studies section was updated from the review (Bassi 2008) in the light of new guidelines published in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).
Contributions of authors
Contributions to present update of review
Conceiving the review: Norma SP Módolo (NSPM) Regina P El Dib (RPED). Co‐ordinating the review: RPED. Undertaking manual searches: Enilze Volpato (EV). Screening search results: Marília P Módolo (MPM), Marcos A Marton (MAM) and Paulo Nascimento Junior (PNJ). Organizing retrieval of papers: EV. Screening retrieved papers against inclusion criteria: NSPM, RPED, MPM and MAM. Appraising quality of papers: NSPM, RPED, MPM and MAM. Abstracting data from papers: NSPM, RPED, MPM and MAM. Writing to authors of papers for additional information: MPM, MAM and Vinícius Monteiro Arantes (VMA). Providing additional data about papers: MPM, MAM and VMA. Obtaining and screening data on unpublished studies: MPM, MAM and PNJ. Providing data management for the review: NSPM and RPED. Entering data into Review Manager (RevMan 5.1): NSPM and RPED. Analyzing RevMan statistical data: RPED. Performing other statistical analyses not using RevMan: RPED. Performing double entry of data: (data entered by person one: NSPM; data entered by person two: RPED). Interpreting data: NSPM, PNJ and RPED. Performing statistical analysis: RPED. Writing the review: NSPM, PNJ and RPED. Securing funding for the review: NSPM and RPED. Performing previous work that was the foundation of the present study: NSPM and RPED. Serving as guarantor for the review (one author): RPED. Taking responsibility for reading and checking review before submission: NSPM and RPED.
Contributions to original review
Adriana Bassi (AB) was responsible for the conception of this review. Regina P El Dib (RPED) and Délcio Matos (DM) were responsible for the design and overall co‐ordination of the protocol. RPED and DM were responsible for co‐ordinating the protocol. AB and Wilson Roberto Milani (WRM) were responsible for designing the search strategy, running searches, screening search results, obtaining papers, screening retrieved papers against the inclusion criteria, appraising the quality of papers and extracting data. AB wrote to authors of papers for additional information and to locate potentially relevant unpublished or ongoing studies. AB, RPED and WRM were responsible for data management in the review. AB, RPED, DM and WRM analysed and interpreted data and wrote up the results.
Sources of support
Internal sources
Own support, Brazil.
External sources
No sources of support supplied
Declarations of interest
Norma SP Módolo: none known.
Marília P Módolo: none known.
Marcos A Marton: none known.
Enilze Volpato: none known.
Vinícius Monteiro Arantes: none known.
Paulo do Nascimento Junior: none known.
Regina P El Dib: paid scientific advisor on systematic review. RPED is also the director and co‐ordinator of the Systematic Review Unit at FMB/Unesp.
Edited (no change to conclusions)
References
References to studies included in this review
Abay 2000 {published data only}
- Abay G, Izgi F, Coruh T, Macika H, Dogusoy I, Aykac Z. The effects of sevoflurane on hypoxic pulmonary vasoconstriction during one‐lung ventilation in thoracic surgery. British Journal of Anaesthesia 2000;84 Suppl 1:A27. [Google Scholar]
Beck 2001 {published data only}
- Beck DH, Doepfmer UR, Sinemus C, Bloch A, Schenk MR, Kox WJ. Effects of sevoflurane and propofol on pulmonary shunt fraction during one‐lung ventilation for thoracic surgery. British Journal of Anaesthesia 2001;86:38‐43. [PUBMED: 11575407] [DOI] [PubMed] [Google Scholar]
De Conno 2009 {published data only}
- Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. Anesthesic‐induced improvement of the inflammatory response to one‐lung ventilation. Anesthesiology 2009;1106:1316‐26. [DOI] [PubMed] [Google Scholar]
Egawa 2009 {published data only}
- Egawa J, Kawaguchi M, Inoue S, Nishiwada T, Furuya H. Cerebral oxygen balance and postoperative cognitive function in patients undergoing lung surgery with one lung ventilation under propofol or sevoflurane anesthesia. Journal of Neurosurgical Anesthesiology 2009;21(4):408‐9. [Google Scholar]
El‐Hakeem 2003 {published data only}
- Abd El‐Hakeem EE, Mohamed MS, Ali SM, El‐Minshawy AM. Haemodynamic and pulmonary shunt fraction changes with sevoflurane or propofol anaesthesia during one‐lung ventilation for thoracic surgery. Egyptian Journal of Anaesthesia 2003;19:233‐41. [Google Scholar]
Fukuoka 2009 {published data only}
- Fukuoka N, Iida H, Akamatsu S, Nagase K, Iwata H, Dohi S. The association between the initial end‐tidal carbon dioxide difference and the lowest arterial oxygen tension value obtained during one‐lung anesthesia with propofol or sevoflurane. Journal of Cardiothoracic and Vascular Anesthesia 2009;23:775‐9. [DOI] [PubMed] [Google Scholar]
Gasowska 1999 {published data only}
- Gasowska J, Brzezinski K, Przesmycki K, Nestorowicz A. Effects of halothane, isoflurane, and propofol on venous admixture during one‐lung ventilation in patients undergoing thoracoscopic procedures. Medical Science Monitor 1999;5:929‐33. [Google Scholar]
Huang 2008 {published data only}
- Huang CH, Wang YP, Wu PY, Chien CT, Cheng YJ. Propofol infusion shortens and attenuates oxidative stress during one lung ventilation. Acta Anaesthesiologica Taiwanica 2008;46(4):160‐5. [DOI] [PubMed] [Google Scholar]
Iwata 2008 {published data only}
- Iwata M, Inoue S, Kawaguchi M, Takahama M, Tojo T, Taniguchi S, et al. Jugular bulb venous oxygen saturation during one‐lung ventilation under sevoflurane‐ or propofol‐based anesthesia for lung surgery. Journal of Cardiothoracic and Vascular Anesthesia 2008;22:71‐6. [DOI] [PubMed] [Google Scholar]
Kellow 1995 {published data only}
- Kellow NH, Scott AD, White SA, Feneck RO. Comparison of the effects of propofol and isoflurane anaesthesia on right ventricular function and shunt fraction during thoracic surgery. British Journal of Anaesthesia 1995;75:578‐82. [PUBMED: 7577284] [DOI] [PubMed] [Google Scholar]
Pilotti 1999 {published data only}
- Pilotti L, Torresini G, Crisci R, Sanctis A, Sanctis C. Total intravenous anesthesia in thoracotomy with one‐lung ventilation [Anestesia totalmente endovenosa nella toracotomia con ventilazione monopolmonare]. Minerva Anestesiologica 1999;65:483‐9. [PUBMED: 10479834] [PubMed] [Google Scholar]
Pruszkowski 2007 {published data only}
- Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law‐Koune JD, Laloe PA. Effects of propofol vs sevoflurane on arterial oxygenation during one‐lung ventilation. British Journal of Anaesthesia 2007;98(4):539‐44. [DOI] [PubMed] [Google Scholar]
Rees 1984 {published data only}
- Rees DI, Gaines GY. One‐lung anesthesia: a comparison of pulmonary gas exchange during anesthesia with ketamine or enflurane. Anesthesia and Analgesia 1984;63:521‐5. [PubMed] [Google Scholar]
Reid 1996 {published data only}
- Reid CW, Slinger PD, Lenis S. A comparison of the effects of propofol‐alfentanil versus isoflurane anesthesia on arterial oxygenation during one‐lung ventilation. Journal of Cardiothoracic and Vascular Anesthesia 1996;10:869‐73. [PUBMED: 8969391] [DOI] [PubMed] [Google Scholar]
Rutkowska 2009 {published data only}
- Rutkowska K, Werszner M, Misiolek H. Comparison of desfluran and propofol anaesthesia for one lung ventilation. Proceedings of the European Anaesthesiology Congress, EUROANAESTHESIA. Milan, Italy, 2009:77‐8.
Schilling 2011 {published data only}
- Schilling T, Kozian A, Senturk M, Huth C, Reinhold A, Hedenstierna G, et al. Effects of volatile and intravenous anesthesia on the alveolar and systemic inflamatory response in thoracic surgical patients. Anesthesiology 2011;115(1):65‐74. [DOI] [PubMed] [Google Scholar]
Schwarzkopf 2009 {published data only}
- Schwarzkopf K, Hueter L, Schreiber T, Preussler NP, Loeb V, Karzai W. Oxygenation during one‐lung ventilation with propofol or sevoflurane. Middle East Journal of Anesthesiology 2009;20(3):397‐400. [PubMed] [Google Scholar]
Spies 1991 {published data only}
- Spies C, Zaune U, Pauli MH, Boeden G, Martin E. A comparison of enflurane and propofol in thoracic surgery [Vergleich von Enfluran und Propofol bei thoraxchirurgischen Eingriffen]. Der Anaesthesist 1991;40:14‐8. [PUBMED: 2006722] [PubMed] [Google Scholar]
Steurer 2007 {published data only}
- Steurer MP, Steurer MA, Spahn DR, Zalunardo MP, Feser M, Schmid ER. One‐lung ventilation: effect of anesthetics on production of inflammatory mediators in the respiratory compartment. Proceedings of the American Thoracic Society International Conference. San Francisco, California, USA, 2007.
Yamada 2008 {published data only}
- Yamada N, Nagata H, Sato Y, Tomoyasu M. Effects of propofol or sevoflurane on cerebral regional oxygen saturation (rSO2) during one‐lung ventilation. The Japanese Journal of Anesthesiology 2008;57(11):1388‐97. [PubMed] [Google Scholar]
References to studies excluded from this review
Abe 1998a {published data only}
- Abe K, Mashimo T, Yoshiya I. Arterial oxygenation and shunt fraction during one‐lung ventilation: a comparison of isoflurane and sevoflurane. Anesthesia and Analgesia 1998a;86:1266‐70. [PUBMED: 9620517] [DOI] [PubMed] [Google Scholar]
Abe 1998b {published data only}
- Abe K, Shimizu T, Takashina M, Shiozaki H, Yoshiya I. The effects of propofol, isoflurane, and sevoflurane on oxygenation and shunt fraction during one‐lung ventilation. Anesthesia and Analgesia 1998b;87:1164‐9. [PUBMED: 9806702] [DOI] [PubMed] [Google Scholar]
Benumof 1987 {published data only}
- Benumof JL, Augustine SD, Gibbons JA. Halothane and isoflurane only slightly impair arterial oxygenation during one‐lung ventilation in patients undergoing thoracotomy. Anesthesiology 1987;67:910‐5. [PUBMED: 3688534] [DOI] [PubMed] [Google Scholar]
Boldt 1996 {published data only}
- Boldt J, Müller M, Uphus D, Padberg W, Hempelmann G. Cardiorespiratory changes in patients undergoing pulmonary resection using different anesthetic management techniques. Journal of Cardiothoracic and Vascular Anesthesia 1996;10:854‐9. [PUBMED: 8969390] [DOI] [PubMed] [Google Scholar]
Bovill 1984 {published data only}
- Bovill JG, Warren PJ, Schuller JL, Wezel HB, Hoeneveld MH. Comparison of fentanyl, sufentanil, and alfentanil anesthesia in patients undergoing valvular heart surgery. Anesthesia and Analgesia 1984;63:1081‐6. [PUBMED: 6239571] [PubMed] [Google Scholar]
Canet 1994 {published data only}
- Canet J, Sanchis J, Zegri A, Llorente C, Navajas D, Casan P. Effects of halothane and isoflurane on ventilation and occlusion pressure. Anesthesiology 1994;81:563‐71. [PUBMED: 8092500] [DOI] [PubMed] [Google Scholar]
Carlsson 1987 {published data only}
- Carlsson AJ, Bindslev L, Hedenstierna G. Hypoxia‐induced pulmonary vasoconstriction in the human lung: the effect of isoflurane anesthesia. Anesthesiology 1987;66:312‐6. [PUBMED: 3826689] [DOI] [PubMed] [Google Scholar]
Celik 2009 {published data only}
- Celik HK, Ustun FE, Celik B, Basoglu A. Effects of desflurane and sevoflurane on oxygenation and shunt fraction during one‐lung ventilation and on recovery time. Turkiye Klinikleri Journal of Medical Sciences 2009;29(5):1222‐9. [Google Scholar]
Cigarini 1990 {published data only}
- Cigarini I, Bonnet F, Lorino AM, Harf A, Desmonts JM. Comparison of the effects of fentanyl on respiratory mechanics under propofol or thiopental anaesthesia. Acta Anaesthesiologica Scandinavica 1990;34:253‐6. [DOI] [PubMed] [Google Scholar]
Dikmen 2003 {published data only}
- Dikmen Y, Eminoglu E, Salihoglu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 2003;58:745‐8. [PUBMED: 12859465] [DOI] [PubMed] [Google Scholar]
Dupont 1999 {published data only}
- Dupont J, Tavernier B, Ghosez Y, Durinck L, Thevenot A, Moktadir‐Chalons N, et al. Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane. British Journal of Anaesthesia 1999;82:355‐9. [PUBMED: 10434815] [DOI] [PubMed] [Google Scholar]
Furugen 1989 {published data only}
- Furugen C, Satoh K, Koh J, Sakaguchi Y, Yanagitani T, Kosaka Y. A‐aDO2 during one lung ventilation under propofol anesthesia. Anesthesia and Resuscitation 1997;33:21‐33. [Google Scholar]
He 1996 {published data only}
- He X, Liu L, Tang Z, Zhao X. The effects of anesthesia with different concentrations of sevoflurane on venous admixture in unilateral lung ventilation. Bulletin of Hunan Medical University 1996;21(5):442‐4. [Google Scholar]
He 1999 {published data only}
- He XJ, Liu L, Chang YT, Zhou JM. Comparison of the effects of inhaling desflurane and isoflurane on pulmonary shunt (Qs/Qt) in one lung ventilation. Chinese Journal of Anesthesiology 1999;19(12):748‐9. [Google Scholar]
Koishi 1998 {published data only}
- Koishi K. The effect of isoflurane anesthesia and total intravenous anesthesia with propofol on SpO2 during one‐lung anesthesia. Journal of the Medical Society of Toho University 1998;45:271‐5. [Google Scholar]
Koishi 1999 {published data only}
- Koishi K, Miyazaki N, Ooe Y. Changes in SpO2 during total intravenous anesthesia combined with propofol and SpO2 during one‐lung anesthesia ventilation. Masui 1999;48:53‐6. [PUBMED: 10036890] [PubMed] [Google Scholar]
Ma 1998 {published data only}
- Ma H, Wang JK, Xu GZ, Zhang L, Shen ZR. The effect of sevoflurane on lung shunt fraction during one‐lung ventilation. Chinese Journal of Anesthesiology 1998;18:67‐9. [Google Scholar]
Merli 1991 {published data only}
- Merli M, Amari B, Ferrante M, Gagliardone MP, Milazzo F, Oppizzi M, et al. Hemodynamic effects of propofol in patients undergoing pulmonary excision and in patients undergoing closed heart mitral valve surgery. Minerva Anestesiologica 1991;57:399‐412. [PUBMED: 1944963] [PubMed] [Google Scholar]
Pagel 1998 {published data only}
- Pagel PS, Fu JL, Damask MC, Davis RF, Samuelson PN, Howie MB, et al. Desflurane and isoflurane produce similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing one‐lung ventilation during thoracotomy. Anesthesia and Analgesia 1998;87:800‐7. [PUBMED: 9768773] [DOI] [PubMed] [Google Scholar]
Pueyo 1994 {published data only}
- Pueyo JA, Pajuelo A, Fuentes R, Bustos A, Guerrero M, Munoz M. Effect of propofol on oxygenation and the pulmonary short‐circuit during single‐lung ventilation [Efecto del propofol sobre la oxigenacion y el cortocircuito pulmonar durante la ventilacion a un solo pulmon]. Revista Española de Anestesiología y Reanimación 1994;41:27‐9. [PUBMED: 8016427] [PubMed] [Google Scholar]
Rogers 1985 {published data only}
- Rogers SN, Benumof JL. Halothane and isoflurane do not decrease PaO2 during one‐lung ventilation in intravenously anesthetized patients. Anesthesia and Analgesia 1985;64:946‐54. [PubMed] [Google Scholar]
Rosso 1995 {published data only}
- Rosso TM, Aguado GR, Vivo M, Nunez M, Grau F. Cardiocirculatory stability and early extubation in patients undergoing thoracic surgery with propofol as the single anesthetic agent [Stabilità cardiocircolatoria ed estubazione precoce nei pazienti sottoposti a chirurgia toracica utilizzando propofol come agente anestetico unico]. Minerva Anestesiologica 1995;61:183‐9. [PUBMED: 7478049] [PubMed] [Google Scholar]
Saito 2000 {published data only}
- Saito M, Cho S, Morooka H, Hasuo H, Shibata O, Sumikawa K. Effects of sevoflurane compared with those of isoflurane on arterial oxygenation and hemodynamics during one‐lung ventilation. Journal of Anesthesia 2000;20:1‐5. [PUBMED: 14564602] [DOI] [PubMed] [Google Scholar]
Satoh 1998 {published data only}
- Satoh D, Sato M, Kaise A, Hagiwara Y, Saishu T, Hashimoto Y. Effects of isoflurane on oxygenation during one‐lung ventilation in pulmonary emphysema patients. Acta Anaesthesiologica Scandinavica 1998;42:1145‐8. [PUBMED: 9834795] [DOI] [PubMed] [Google Scholar]
Shimizu 1997 {published data only}
- Shimizu T, Abe K, Kinouchi K, Yoshiya I. Arterial oxygenation during one lung ventilation. Canadian Journal of Anaesthesia 1997;44:1162‐6. [DOI] [PubMed] [Google Scholar]
Sjögren 1995 {published data only}
- Sjogren D, Sollevi A, Ebberyd A, Lindahl SG. Isoflurane anaesthesia (0.6 MAC) and hypoxic ventilatory responses in humans. Acta Anaesthesiologica Scandinavica 1995;39:17‐22. [PUBMED: 7725878] [DOI] [PubMed] [Google Scholar]
Slinger 1988 {published data only}
- Slinger P, Triolet W, Wilson J. Improving arterial oxygenation during one‐lung ventilation. Anesthesiology 1988;68:291‐5. [PUBMED: 3277487] [DOI] [PubMed] [Google Scholar]
Slinger 1995 {published data only}
- Slinger P, Scott WA. Arterial oxygenation during one‐lung ventilation. A comparison of enflurane and isoflurane. Anesthesiology 1995;82:940‐6. [PUBMED: 7717566] [DOI] [PubMed] [Google Scholar]
Solares 1992 {published data only}
- Solares G, Castro A, Villanueva M, Garcia Izquierdo M, Buitrago PM. Effect of isoflurane on gas exchange and systemic and pulmonary hemodynamics in man during single lung ventilation [Efecto del isoflurano sobre el intercambio gaseoso y la hemodinamica sistemica y pulmonar en el hombre durante la ventilacion a un solo pulmon]. Revista Española de Anestesiología y Reanimación 1992;39:221‐6. [PUBMED: 1513938] [PubMed] [Google Scholar]
Steegers 1990 {published data only}
- Steegers PA, Backx PJ. Propofol and alfentanil anesthesia during one‐lung ventilation. Journal of Cardiothoracic Anesthesia 1990;4:194‐9. [PUBMED: 2131866] [DOI] [PubMed] [Google Scholar]
Temp 1992 {published data only}
- Temp JA, Henson LC, Ward DS. Does a subanesthetic concentration of isoflurane blunt the ventilatory response to hypoxia?. Anesthesiology 1992;77:1116‐24. [DOI] [PubMed] [Google Scholar]
Van Keer 1989 {published data only}
- Keer L, Aken H, Vandermeersch E, Vermaut G, Lerut T. Propofol does not inhibit hypoxic pulmonary vasoconstriction in humans. Journal of Clinical Anesthesia 1989;1:284‐8. [DOI] [PubMed] [Google Scholar]
Van Leeuwen 1990 {published data only}
- Leeuwen L, Zuurmond WW, Deen L, Helmers HJ. Total intravenous anaesthesia with propofol, alfentanil, and oxygen‐air: three different dosage schemes. Canadian Journal of Anaesthesia 1990;37:282‐6. [PUBMED: 2182204] [DOI] [PubMed] [Google Scholar]
Wang 1998 {published data only}
- Wang JY, Russell GN, Page RD, Jackson M, Pennefather SH. Comparison of the effects of sevoflurane and isoflurane on arterial oxygenation during one lung ventilation. British Journal of Anaesthesia 1998;81:850‐3. [PUBMED: 10211007] [DOI] [PubMed] [Google Scholar]
Wang 2000 {published data only}
- Wang JY, Russell GN, Page RD, Oo A, Pennefather SH. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one‐lung ventilation. Anaesthesia 2000;55:167‐73. [PUBMED: 10651681] [DOI] [PubMed] [Google Scholar]
Yamada 1990 {published data only}
- Yamada M, Ochiai R, Takeda J, Nagano M. Does anesthetic technique affect the oxygenation during one lung anesthesia?. Canadian Journal of Anaesthesia 1990;37:S164. [PUBMED: 2361279] [PubMed] [Google Scholar]
Yondov 1999 {published data only}
- Yondov D, Kounev V, Ivanov O, Prisadov G, Semerdjieva M. A comparative study of the effect of halothane, isoflurane and propofol on partial arterial oxygen pressure during one‐lung ventilation in thoracic surgery. Folia Medica 1999;41(3):45‐51. [PUBMED: 10658366] [PubMed] [Google Scholar]
References to studies awaiting assessment
Erturk 2014 {published data only}
- Erturk E, Topaloglu S, Dohman D, Kutanis D, Beşir A, Demirci Y, et al. The comparison of the effects of sevoflurane inhalation anesthesia and intravenous propofol anesthesia on oxidative stress in one lung ventilation. Biomed Research International 2014;360936:Epub 2014 Jan 5. [PUBMED: 24527444] [DOI] [PMC free article] [PubMed] [Google Scholar]
Hammouda 2013 {published data only}
- Hammouda SA, Rabbiha AAA, AlGanady AA, Ghoneima TA, Elsawyc MM, Youssif SA, et al. Immunomodulatory effect of propofol versus sevoflurane in patients undergoing thoracic surgery using one lung ventilation technique. Egyptian Journal of Chest Diseases and Tuberculosis 2013;62:731‐43. [Google Scholar]
Potočnik 2014 {published data only}
- Potočnik I, Novak Janković V, Šostarič M, Jerin A, Štupnik T, Skitek M, et al. Antiinflammatory effect of sevoflurane in open lung surgery with one‐lung ventilation. Croatian Medical Journal 2014;55(6):628‐37. [PUBMED: 25559834] [DOI] [PMC free article] [PubMed] [Google Scholar]
Wakabayashi 2014 {published data only}
- Wakabayashi S, Yamaguchi K, Kumakura S, Murakami T, Someya A, Kajiyama Y, et al. Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy. International Journal of Molecular Medicine 2014;34(1):137‐44. [PUBMED: 24788377] [DOI] [PubMed] [Google Scholar]
Additional references
Domino 1986
- Domino KB, Borowec L, Alexander CM, Williams JJ, Chen L, Marshall C, et al. Influence of isoflurane on hypoxic pulmonary vasoconstriction in dogs. Anesthesiology 1986;64(4):423‐9. [DOI] [PubMed] [Google Scholar]
Friedlander 1994
- Friedlander M, Sandler A, Kavanagh B, Winton T, Benumof J. Is hypoxic pulmonary vasoconstriction important during single lung ventilation in the lateral decubitus position?. Canadian Journal of Anaesthesia 1994;41(1):26‐30. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Gupta 2004
- Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg 2004;98(3):632‐41. [DOI] [PubMed] [Google Scholar]
Harpole 1999
- Harpole DH Jr, DeCamp MM Jr, Daley J, Hur K, Oprian CA, Henderson WG, et al. Prognostic models of thirty‐day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg 1999;117(5):969‐79. [DOI] [PubMed] [Google Scholar]
Higgins 2003
- Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. [MEDLINE: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Higgins 2011
- Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org. [Google Scholar]
Loer 1995
- Loer SA, Scheeren TW, Tarnow J. Desflurane inhibits hypoxic pulmonary vasoconstriction in isolated rabbit lungs. Anesthesiology 1995;83(3):552‐6. [DOI] [PubMed] [Google Scholar]
Marshall 1984
- Marshall C, Lindgren L, Marshall BE. Effects of halothane, enflurane, and isoflurane on hypoxic pulmonary vasoconstriction in rat lungs in vitro. Anesthesiology 1984;60:304‐8. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Morgan 2001
- Morgan GE, Mikhail MS, Murray MJ, Larson CPJ. Anesthesia for thoracic surgery. Clinical Anesthesiology. 3rd Edition. New York: McGraw‐Hill, 2001:525‐51. [Google Scholar]
Ozkose 2001
- Ozkose Z, Ercan B, Unal Y, Yardim S, Kaymaz M, Dogulu F, et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost. J Neurosurg Anesthesiol 2001;13(4):296‐302. [DOI] [PubMed] [Google Scholar]
RevMan 5.1 [Computer program]
- The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Wada 1998
- Wada H, Nakamura T, Nakamoto K, Maeda M, Watanabe Y. Thirty‐day operative mortality for thoracotomy in lung cancer. J Thorac Cardiovasc Surg 1998;115(1):70‐3. [DOI] [PubMed] [Google Scholar]
Zeng 2010
- Zeng ZY, Pan LH, Lin F. Effects of thoracic epidural anesthesia combined with general anesthesia on arterial oxygenation and intrapulmonary shunting during one‐lung ventilation: a systematic review. Chinese Journal of Evidence‐Based Medicine 2010;10(12):1450‐55. [Google Scholar]
References to other published versions of this review
Bassi 2008
- Bassi A, Milani WRO, Dib R, Matos D. Intravenous versus inhalation anaesthesia for one‐lung ventilation. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD006313.pub2] [DOI] [PubMed] [Google Scholar]