Skip to main content
Top
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

Effects of sevoflurane and propofol on the development of pneumonia after esophagectomy: a retrospective cohort study

Authors: Guo-Hua Zhang, Wen Wang

Published in: BMC Anesthesiology | Issue 1/2017

Login to get access

Abstract

Background

Postoperative pneumonia (PP) is one of the common complications following esophagectomy and associated with poor short- and long-term outcomes. Sevoflurane and propofol, which have inflammatory-modulating effects, are common used general anesthetics. This study aimed to compare the effects of anesthesia with sevoflurane and propofol on the development of PP after esophageal surgery for cancer.

Methods

The electronic medical records of patients who underwent elective esophagectomy between July 2013 and July 2016 were reviewed. We conducted univariate and multivariate logistics analysis and propensity score matching analysis to compare the effect of sevoflurane and propofol on the incidence of PP and to identify the risk factors for PP after esophagectomy.

Results

Overall, the incidence of postoperative pneumonia was 9.5%. There was no significant difference in the rates of PP between sevoflurane group and propofol group either before or after propensity score matching (9.6% vs 8.0%, P = 0.606; 7.7% vs 6.4%, P = 0.754, respectively). Univariate and multivariate analysis revealed that alcohol use (OR 1.513; 95% CI 1.062–2.156), surgical procedure (Sweet: referent; Ivor-Lewis: OR 1.993; 95% CI 1.190–3.337; Three-incision: OR 1.878; 95% CI 1.296–2.722) and surgeon experience (high-volume: referent; low-volume: OR 1.525; 95% CI 1.090–2.135) were significant risk factors of postoperative pneumonia.

Conclusions

Sevoflurane did not differ from propofol in terms of affecting the risk of PP development after esophagectomy.
Literature
1.
go back to reference van der Sluis PC, Verhage RJ, van der Horst S, van der Wal WM, Ruurda JP, van Hillegersberg R. A new clinical scoring system to define pneumonia following esophagectomy for cancer. Dig Surg. 2014;31:108–16.CrossRefPubMed van der Sluis PC, Verhage RJ, van der Horst S, van der Wal WM, Ruurda JP, van Hillegersberg R. A new clinical scoring system to define pneumonia following esophagectomy for cancer. Dig Surg. 2014;31:108–16.CrossRefPubMed
2.
go back to reference Goense L, van Rossum PS, Tromp M, Joore HC, van Dijk D, Kroese AC, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus. 2017;30:1–10.PubMed Goense L, van Rossum PS, Tromp M, Joore HC, van Dijk D, Kroese AC, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus. 2017;30:1–10.PubMed
3.
go back to reference Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K, et al. The impact of postoperative complications on survivals after Esophagectomy for esophageal cancer. Medicine (Baltimore). 2015;94:e1369.CrossRef Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K, et al. The impact of postoperative complications on survivals after Esophagectomy for esophageal cancer. Medicine (Baltimore). 2015;94:e1369.CrossRef
4.
go back to reference Yoshida N, Watanabe M, Baba Y, Iwagami S, Ishimoto T, Iwatsuki M, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefPubMed Yoshida N, Watanabe M, Baba Y, Iwagami S, Ishimoto T, Iwatsuki M, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefPubMed
5.
go back to reference Okamura A, Watanabe M, Mine S, Nishida K, Kurogochi T, Imamura Y. Spirometric lung age predicts postoperative pneumonia after Esophagectomy. World J Surg. 2016;40:2412–8.CrossRefPubMed Okamura A, Watanabe M, Mine S, Nishida K, Kurogochi T, Imamura Y. Spirometric lung age predicts postoperative pneumonia after Esophagectomy. World J Surg. 2016;40:2412–8.CrossRefPubMed
6.
go back to reference Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88:1241–9.CrossRefPubMed Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88:1241–9.CrossRefPubMed
7.
go back to reference Molena D, Mungo B, Stem M, Lidor AO. Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis. Semin Thorac Cardiovasc Surg. 2014;26:287–94.CrossRefPubMed Molena D, Mungo B, Stem M, Lidor AO. Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis. Semin Thorac Cardiovasc Surg. 2014;26:287–94.CrossRefPubMed
8.
go back to reference Ntutumu R, Liu H, Zhen L, YF H, Mou TY, Lin T, et al. Risk factors for pulmonary complications following laparoscopic gastrectomy: a single-center study. Medicine (Baltimore). 2016;95:e4567.CrossRef Ntutumu R, Liu H, Zhen L, YF H, Mou TY, Lin T, et al. Risk factors for pulmonary complications following laparoscopic gastrectomy: a single-center study. Medicine (Baltimore). 2016;95:e4567.CrossRef
9.
go back to reference Lee JJ, Kim GH, Kim JA, Yang M, Ahn HJ, Sim WS, et al. Comparison of pulmonary morbidity using sevoflurane or propofol-remifentanil anesthesia in an Ivor Lewis operation. J Cardiothorac Vasc Anesth. 2012;26:857–62.CrossRefPubMed Lee JJ, Kim GH, Kim JA, Yang M, Ahn HJ, Sim WS, et al. Comparison of pulmonary morbidity using sevoflurane or propofol-remifentanil anesthesia in an Ivor Lewis operation. J Cardiothorac Vasc Anesth. 2012;26:857–62.CrossRefPubMed
10.
go back to reference Tsujimoto H, Takahata R, Nomura S, Kumano I, Matsumoto Y, Yoshida K, et al. Predictive value of pleural and serum interleukin-6 levels for pneumonia and hypo-oxygenations after esophagectomy. J Surg Res. 2013;182:e61–7.CrossRefPubMed Tsujimoto H, Takahata R, Nomura S, Kumano I, Matsumoto Y, Yoshida K, et al. Predictive value of pleural and serum interleukin-6 levels for pneumonia and hypo-oxygenations after esophagectomy. J Surg Res. 2013;182:e61–7.CrossRefPubMed
11.
go back to reference D'Journo XB, Michelet P, Marin V, Diesnis I, Blayac D, Doddoli C, et al. An early inflammatory response to oesophagectomy predicts the occurrence of pulmonary complications. Eur J Cardiothorac Surg. 2010;37:1144–51.CrossRefPubMed D'Journo XB, Michelet P, Marin V, Diesnis I, Blayac D, Doddoli C, et al. An early inflammatory response to oesophagectomy predicts the occurrence of pulmonary complications. Eur J Cardiothorac Surg. 2010;37:1144–51.CrossRefPubMed
12.
go back to reference Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996;24:163–72.CrossRefPubMed Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996;24:163–72.CrossRefPubMed
13.
go back to reference 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 inflammatory response in thoracic surgical patients. Anesthesiology. 2011;115:65–74.CrossRefPubMed 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 inflammatory response in thoracic surgical patients. Anesthesiology. 2011;115:65–74.CrossRefPubMed
14.
go back to reference Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Buhling F, et al. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth. 2007;99:368–75.CrossRefPubMed Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Buhling F, et al. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth. 2007;99:368–75.CrossRefPubMed
15.
go back to reference Kawamura T, Kadosaki M, Nara N, Kaise A, Suzuki H, Endo S, et al. Effects of sevoflurane on cytokine balance in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2006;20:503–8.CrossRefPubMed Kawamura T, Kadosaki M, Nara N, Kaise A, Suzuki H, Endo S, et al. Effects of sevoflurane on cytokine balance in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2006;20:503–8.CrossRefPubMed
16.
go back to reference Song XM, Wang YL, Li JG, Wang CY, Zhou Q, Zhang ZZ, et al. Effects of propofol on pro-inflammatory cytokines and nuclear factor kappaB during polymicrobial sepsis in rats. Mol Biol Rep. 2009;36:2345–51.CrossRefPubMed Song XM, Wang YL, Li JG, Wang CY, Zhou Q, Zhang ZZ, et al. Effects of propofol on pro-inflammatory cytokines and nuclear factor kappaB during polymicrobial sepsis in rats. Mol Biol Rep. 2009;36:2345–51.CrossRefPubMed
17.
go back to reference Sanchez-Conde P, Rodriguez-Lopez JM, Nicolas JL, Lozano FS, Garcia-Criado FJ, Cascajo C, et al. The comparative abilities of propofol and sevoflurane to modulate inflammation and oxidative stress in the kidney after aortic cross-clamping. Anesth Analg. 2008;106:371–8. table of contentsCrossRefPubMed Sanchez-Conde P, Rodriguez-Lopez JM, Nicolas JL, Lozano FS, Garcia-Criado FJ, Cascajo C, et al. The comparative abilities of propofol and sevoflurane to modulate inflammation and oxidative stress in the kidney after aortic cross-clamping. Anesth Analg. 2008;106:371–8. table of contentsCrossRefPubMed
18.
go back to reference Hsiao HT, Wu H, Huang PC, Tsai YC, Liu YC. The effect of propofol and sevoflurane on antioxidants and proinflammatory cytokines in a porcine ischemia-reperfusion model. Acta Anaesthesiol Taiwanica. 2016;54:6–10.CrossRef Hsiao HT, Wu H, Huang PC, Tsai YC, Liu YC. The effect of propofol and sevoflurane on antioxidants and proinflammatory cytokines in a porcine ischemia-reperfusion model. Acta Anaesthesiol Taiwanica. 2016;54:6–10.CrossRef
19.
go back to reference American Thoracic S. Infectious diseases Society of a. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRef American Thoracic S. Infectious diseases Society of a. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRef
20.
go back to reference Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Annu Rev Public Health. 2000;21:121–45.CrossRefPubMed Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Annu Rev Public Health. 2000;21:121–45.CrossRefPubMed
21.
go back to reference De Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.CrossRefPubMed De Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.CrossRefPubMed
22.
go back to reference Potocnik I, Novak Jankovic V, Sostaric M, Jerin A, Stupnik T, Skitek M, et al. Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation. Croat Med J. 2014;55:628–37.CrossRefPubMedPubMedCentral Potocnik I, Novak Jankovic V, Sostaric M, Jerin A, Stupnik T, Skitek M, et al. Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation. Croat Med J. 2014;55:628–37.CrossRefPubMedPubMedCentral
23.
go back to reference Sun B, Wang J, Bo L, Zang Y, Gu H, Li J, et al. Effects of volatile vs. propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilation: a meta-analysis of randomized controlled trials. J Anesth. 2015;29:570–9.CrossRefPubMed Sun B, Wang J, Bo L, Zang Y, Gu H, Li J, et al. Effects of volatile vs. propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilation: a meta-analysis of randomized controlled trials. J Anesth. 2015;29:570–9.CrossRefPubMed
24.
go back to reference Morita M, Yoshida R, Ikeda K, Egashira A, Oki E, Sadanaga N, et al. Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. Dis Esophagus. 2008;21:30–6.CrossRefPubMed Morita M, Yoshida R, Ikeda K, Egashira A, Oki E, Sadanaga N, et al. Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. Dis Esophagus. 2008;21:30–6.CrossRefPubMed
25.
go back to reference Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardó T, et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiol. 2016;82(7):735–42.PubMed Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardó T, et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiol. 2016;82(7):735–42.PubMed
Metadata
Title
Effects of sevoflurane and propofol on the development of pneumonia after esophagectomy: a retrospective cohort study
Authors
Guo-Hua Zhang
Wen Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0458-4

Other articles of this Issue 1/2017

BMC Anesthesiology 1/2017 Go to the issue