Volatile anesthetics versus intravenous anesthetics for noncardiac thoracic surgery: a systematic review and meta-analysis

INTRODUCTION: We performed this meta-analysis of randomized controlled trials (RCTs) to investigate two types of anesthetics for noncardiac thoracic surgery regarding their effects on clinical outcomes and the inflammatory response. EVIDENCE ACQUISITION: We searched Cochrane Library, PubMed and Embase for RCTs comparing volatile anesthetics to intravenous anesthetics for noncardiac thoracic surgery. EVIDENCE SYNTHESIS: This study reviewed 16 RCTs with 1467 patients. Volatile anesthetics reduced postoperative complications and the length of intensive care unit stay for lung surgery. They also lowered the concentrations of interleukin (IL)-1 beta, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-alpha) in the airways of patients undergoing noncardiac thoracic surgery. However, there was no difference in short-term mortality, postoperative complications after esophagectomy, IL-1 beta, IL-6, IL-8 or TNF-alpha concentrations in the blood, IL-10 level in either the airway or the blood, overall monocyte chemoattractant protein-1. CONCLUSIONS: In lung surgery, but not esophagectomy, volatile anesthetics may be a better choice than intravenous anesthetics, possibly because volatile anesthetics reduce airway inflammation.