Yao Y, Zhang MS, Li YB, Zhang MZ. Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty. World J Clin Cases 2023; 11(31): 7619-7628 [PMID: 38078146 DOI: 10.12998/wjcc.v11.i31.7619]
Corresponding Author of This Article
Ming-Zhe Zhang, MSc, Attending Doctor, Department of Anesthesiology, Dingzhou People’s Hospital, Jianshe Street, Dingzhou 073000, Hebei Province, China. 15194968994@163.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuan Yao, Department of Anesthesiology, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
Man-Si Zhang, Department of Pharmacy, Shangrao Municipal Hospital, Shangrao 334000, Jiangxi Province, China
Yue-Bing Li, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang Province, China
Ming-Zhe Zhang, Department of Anesthesiology, Dingzhou People’s Hospital, Dingzhou 073000, Hebei Province, China
Author contributions: Yao Y and Zhang MZ proposed the concept of this study; Yao Y and Li YB have made contributions to data collection; Yao Y and Zhang MS contributed to formal analysis; Yao Y, Zhang MS, and Zhang MZ participated in the survey; Yao Y has contributed to these methods and prepared the first draft; Li YB and Zhang MZ guided the research; Yao Y validated this study; Zhang MZ and Li YB contributed to the visualization of this study; Yao Y, Zhang MZ, Li YB, and Zhang MS jointly reviewed and edited the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Committee of Jiaxing Second Hospital.
Clinical trial registration statement: This study was registered in February 2018. Registration identification number is ChiCTR1900021234.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: September 19, 2023 Peer-review started: September 19, 2023 First decision: October 8, 2023 Revised: October 10, 2023 Accepted: October 23, 2023 Article in press: October 23, 2023 Published online: November 6, 2023 Processing time: 48 Days and 0.9 Hours
Abstract
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications (PPCs) after major surgeries. Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.
AIM
To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty (THA).
METHODS
In this randomized controlled trial, we randomly assigned 120 elderly patients with COPD, who were scheduled for THA, to receive either sevoflurane (sevoflurane group) or propofol (propofol group) as the maintenance anesthetic. The primary outcome was the incidence of PPCs within seven days after surgery. The secondary outcomes were changes in the lung function parameters, inflammatory markers, oxidative stress markers, and postoperative pain scores.
RESULTS
The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group (10% vs 25%, P = 0.02). Furthermore, the decline in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery (P < 0.05). The interleukin-6, tumor necrosis factor-alpha, malondialdehyde, and 8-hydroxy-2 α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery (P < 0.05). The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h, 12 h, and 24 h after surgery (P < 0.05).
CONCLUSION
Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs, attenuating inflammatory and oxidative stress responses, and alleviating postoperative pain.
Core Tip: Sevoflurane exhibits a protective effect on lung function in elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty. It reduces the incidence of postoperative pulmonary complications, improves lung function parameters, and decreases inflammatory and oxidative stress markers. Additionally, it alleviates postoperative pain. These findings highlight the potential benefits of using sevoflurane as an anesthesia choice for this patient population.
