Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

ARTICLE HIGHLIGHTS

Research background

Chronic obstructive pulmonary disease (COPD) is a prevalent and progressive respiratory disorder that primarily affects the elderly population. COPD is associated with significant morbidity and mortality and poses challenges in the perioperative management of elderly patients undergoing major surgeries. Postoperative pulmonary complications (PPCs) are a frequent and serious concern in this patient population, leading to increased healthcare utilization, prolonged hospital stays, and compromised patient outcomes.

Research motivation

The study aimed to compare the incidence of PPCs and changes in lung function parameters, inflammatory and oxidative stress markers, and postoperative pain scores in elderly COPD patients receiving either sevoflurane or propofol as the maintenance anesthetic during total hip arthroplasty (THA).

Research objectives

The main objective of this study was to evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing THA.

Research methods

This study utilized a randomized controlled trial design to assess the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing THA. Random assignment of 120 patients to either the sevoflurane or propofol group minimized bias. During surgery, patients in the sevoflurane group received sevoflurane as the maintenance anesthetic, while those in the propofol group received propofol. The primary outcome was the incidence of PPCs within seven days, and secondary outcomes included changes in lung function parameters, inflammatory and oxidative stress markers, and postoperative pain scores. The study concluded that sevoflurane administration significantly reduced PPCs, mitigated inflammation and oxidative stress responses, and improved postoperative pain. The novelty of this research lies in its focus on elderly COPD patients undergoing THA and the comparison of sevoflurane and propofol in this population. This randomised controlled trial provides robust evidence for the protective effects of sevoflurane and its potential benefits in perioperative care for elderly COPD patients.

Research results

The study findings revealed that sevoflurane administration during THA under general anesthesia significantly reduced the incidence of PPCs in elderly COPD patients compared to propofol. The sevoflurane group also exhibited a lesser decline in lung function parameters, which included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF), at 24 h and 48 h after surgery. Furthermore, sevoflurane administration was associated with significantly lower levels of inflammatory and oxidative stress markers, such as interleukin-6, tumor necrosis factor-alpha, malondialdehyde, and 8-hydroxy-2 α-deoxyguanosine, at 24 h after surgery. The sevoflurane group also exhibited significantly lower postoperative pain scores at 6 h, 12 h, and 24 h after surgery. Therefore, the study concluded that sevoflurane administration provides protective effects on lung function, attenuates inflammatory and oxidative stress responses, and alleviates postoperative pain in elderly COPD patients undergoing THA. Additionally, the study did not evaluate long-term outcomes or the potential impact of sevoflurane on mortality or quality of life. Future studies should address these limitations to further advance knowledge in the field of perioperative care for elderly COPD patients.

Research conclusions

This study provides evidence that sevoflurane administration during THA in elderly COPD patients under general anesthesia significantly reduces the incidence of PPCs, mitigates inflammatory and oxidative stress responses, and alleviates postoperative pain. Sevoflurane also exhibits a protective effect on lung function, as demonstrated by a lesser decline in lung function parameters, including FEV1, FVC, and PEF, at 24 h and 48 h after surgery. These findings support the potential clinical use of sevoflurane in the perioperative management of elderly COPD patients undergoing major surgeries, particularly THA. Further research is needed to explore the generalizability of these findings and evaluate their long-term impact on patient outcomes.

Research perspectives

The findings of this study provide valuable insights into the potential benefits of sevoflurane in protecting the lung function of elderly COPD patients undergoing major surgeries, specifically THA. Future research can build upon these findings in several ways. First, additional studies should explore the generalizability of these results to other surgical procedures and patient populations. This would enhance our understanding of the broader applicability of sevoflurane’s protective effects. Second, long-term outcomes, such as mortality rates and quality of life measures, should be investigated to assess the sustained impact of sevoflurane on patient outcomes. Furthermore, further investigations are warranted to elucidate the underlying mechanisms through which sevoflurane exerts its protective effects, including its anti-inflammatory and antioxidant properties. Overall, these research perspectives can enhance the knowledge and clinical implications of sevoflurane administration in perioperative care for elderly COPD patients.