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.
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.
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.
The objective of this review was to evaluate the effectiveness and safety of intravenous versus inhalation anaesthesia for one-lung ventilation.
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.
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).
Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information.
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'.