{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:17:27Z","timestamp":1787847447257,"version":"build-2784847793"},"reference-count":60,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>The anesthesia regimen used during one lung ventilation (OLV) carry the potential to affect intra-operative course and post-operative outcomes, by its effects on pulmonary vasculature and alveolar inflammation. This narrative review aims to understand the pathophysiology of acute lung injury during one lung ventilation, and to study the effects of inhalational versus intravenous anaesthetics on intraoperative and post-operative outcomes, following thoracic surgery. For this purpose, we independently searched 'PubMed', 'Google Scholar' and 'Cochrane Central' databases to find out randomized controlled trials (RCTs), in English language, which compared the effects of intravenous versus inhalational anaesthetics on intraoperative and post-operative outcomes, in elective thoracic surgeries, in human beings. In total, 38 RCTs were included in this review. Salient results of the review are- Propofol reduced intraoperative shunt and maintained better intraoperative oxygenation than inhalational agents. However, use of modern inhalational anaesthetics during OLV reduced alveolar inflammation significantly, as compared to propofol. Regarding post-operative complications, the evidence is not conclusive enough but slightly in favour of inhalational anaesthetics. Thus, we conclude that modern inhalational anaesthetics, by their virtue of better anti-inflammatory properties, exhibit lung protective effects and hence, seem to be safe for maintenance of anesthesia during OLV in elective thoracic surgeries. Further research is required to establish the safety of these agents with respect to long term post-operative outcomes like cancer recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_1106_20","type":"journal-article","created":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T10:06:40Z","timestamp":1624097200000},"page":"312-323","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Inhalational versus intravenous anesthetics during one lung ventilation in elective thoracic surgeries"],"prefix":"10.4103","volume":"15","author":[{"given":"Swapnil","family":"Parab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheetal","family":"Gaikwad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saratchandra","family":"Majeti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-8-20240909","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1016\/j.athoracsur.2005.11.048","article-title":"Operative mortality and respiratory complications after lung resection for cancer: Impact of chronic obstructive pulmonary disease and time trends","volume":"81","author":"Licker","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"R2-8-20240909","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1213\/ANE.0000000000000808","article-title":"Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung","volume":"121","author":"Lohser","year":"2015","journal-title":"Anesth Analg"},{"key":"R3-8-20240909","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1213\/ANE.0b013e3182975b85","article-title":"Special article: The endothelial glycocalyx: Emerging concepts in pulmonary edema and acute lung injury","volume":"117","author":"Collins","year":"2013","journal-title":"Anesth Analg"},{"key":"R4-8-20240909","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1183\/09031936.02.00295102","article-title":"Systemic cytokine levels in community-acquired pneumonia and their association with disease severity","volume":"20","author":"Antunes","year":"2002","journal-title":"Eur Respir J"},{"key":"R5-8-20240909","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1097\/01.tp.0000237207.73439.2e","article-title":"Isoflurane inhalation after circulatory arrest protects against warm ischemia reperfusion injury of the lungs","volume":"82","author":"Fujinaga","year":"2006","journal-title":"Transplantation"},{"key":"R6-8-20240909","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3109\/08941939.2011.618524","article-title":"Ischemia-reperfusion-induced unmeasured anion generation and glycocalyx shedding: Sevoflurane versus propofol anesthesia","volume":"25","author":"Annecke","year":"2012","journal-title":"J Invest Surg"},{"key":"R7-8-20240909","doi-asserted-by":"crossref","first-page":"781","DOI":"10.3892\/etm.2013.1194","article-title":"Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one-lung ventilation","volume":"6","author":"s","year":"2013","journal-title":"Exp Ther Med"},{"key":"R8-8-20240909","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R9-8-20240909","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/bja\/aem184","article-title":"Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation","volume":"99","author":"Schilling","year":"2007","journal-title":"Br J Anaesth"},{"key":"R10-8-20240909","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1097\/ALN.0b013e3181a10731","article-title":"Anesthetic- induced improvement of the inflammatory response to one lung ventilation","volume":"110","author":"De Conno","year":"2009","journal-title":"Anesthesiology"},{"key":"R11-8-20240909","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1007\/s00540-011-1100-0","article-title":"The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection","volume":"25","author":"Sugasawa","year":"2011","journal-title":"J Anesth"},{"key":"R12-8-20240909","first-page":"317410","article-title":"Immunomodulatory effects of anesthetics during thoracic surgery?","volume":"2011","author":"Mahmoud","year":"2011","journal-title":"Anesthesiol Res Pract"},{"key":"R13-8-20240909","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/ALN.0b013e318214b9de","article-title":"Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients","volume":"115","author":"Schilling","year":"2011","journal-title":"Anesthesiology"},{"key":"R14-8-20240909","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.ejcdt.2013.08.005","article-title":"Immunomodulatory effect of propofol versus sevoflurane in patients undergoing thoracic surgery using one lung ventilation technique","volume":"62","author":"Hammouda","year":"2013","journal-title":"Egypt J Chest Dis Tuberc"},{"key":"R15-8-20240909","doi-asserted-by":"crossref","first-page":"628","DOI":"10.3325\/cmj.2014.55.628","article-title":"Anti-inflammatory effect of sevoflurane in open lung surgery with one-lung ventilation","volume":"55","author":"Poto\u010dnik","year":"2014","journal-title":"Croat Med J"},{"key":"R16-8-20240909","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/bja\/aex230","article-title":"Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia","volume":"119","author":"de la Gala","year":"2017","journal-title":"Br J Anaesth"},{"key":"R17-8-20240909","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1053\/j.jvca.2012.01.015","article-title":"Comparison of pulmonary morbidity using sevoflurane or propofol-remifentanil anesthesia in an Ivor Lewis operation","volume":"26","author":"Lee","year":"2012","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R18-8-20240909","doi-asserted-by":"crossref","first-page":"781","DOI":"10.3892\/etm.2013.1194","article-title":"Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one-lung ventilation","volume":"6","author":"Jin","year":"2013","journal-title":"Exp Ther Med"},{"key":"R19-8-20240909","doi-asserted-by":"crossref","first-page":"137","DOI":"10.3892\/ijmm.2014.1762","article-title":"Effects of anesthesia with sevoflurane and propofol on the cytokine\/chemokine production at the airway epithelium during esophagectomy","volume":"34","author":"Wakabayashi","year":"2014","journal-title":"Int J Mol Med"},{"key":"R20-8-20240909","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.21037\/jtd.2018.03.44","article-title":"Sevoflurane did not show better protective effect on endothelial glycocalyx layer compared to propofol during lung resection surgery with one lung ventilation","volume":"10","author":"Kim","year":"2018","journal-title":"J Thorac Dis"},{"key":"R21-8-20240909","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1007\/s00540-015-1987-y","article-title":"Effects of volatile vs.propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilation: A meta-analysis of randomized controlled trials","volume":"29","author":"Sun","year":"2015","journal-title":"J Anesth"},{"key":"R22-8-20240909","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1875-4597(09)60003-5","article-title":"Propofol infusion shortens and attenuates oxidative stress during one lung ventilation","volume":"46","author":"Huang","year":"2008","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"R23-8-20240909","doi-asserted-by":"crossref","first-page":"360936","DOI":"10.1155\/2014\/360936","article-title":"The comparison of the effects of sevoflurane inhalation anesthesia and intravenous propofol anesthesia on oxidative stress in one lung ventilation?","volume":"2014","author":"Erturk","year":"2014","journal-title":"Biomed Res Int"},{"key":"R24-8-20240909","first-page":"13634","article-title":"Effects of sevoflurane preconditioning on lung injury during one lung ventilation","volume":"8","author":"Feng","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"R25-8-20240909","first-page":"272","article-title":"Effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients undergone esophagectomy","volume":"7","author":"Xu","year":"2013","journal-title":"Int J Clin Exp Pathol"},{"key":"R26-8-20240909","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/ALN.0000000000001164","article-title":"Which anesthesia regimen is best to reduce morbidity and mortality in lung surgery? A multicenter randomized controlled trial","volume":"125","author":"Beck-Schimmer","year":"2016","journal-title":"Anesthesiology"},{"key":"R27-8-20240909","doi-asserted-by":"crossref","first-page":"e12845","DOI":"10.1097\/MD.0000000000012845","article-title":"Reduction of oxidative stress a key for enhanced postoperative recovery with fewer complications in esophageal surgery patients: Randomized control trial to investigate therapeutic impact of anesthesia management and usefulness of simple blood test for prediction of high-risk patients","volume":"97","author":"Tsuchiya","year":"2018","journal-title":"Medicine (Baltimore"},{"key":"R28-8-20240909","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.23736\/S0375-9393.18.12501-6","article-title":"Effects of inhalation and intravenous anesthesia on intraoperative cardiopulmonary function and postoperative complications in patients undergoing thoracic surgery","volume":"84","author":"Pang","year":"2018","journal-title":"Minerva Anestesiol"},{"key":"R29-8-20240909","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1093\/bja\/75.5.578","article-title":"Comparison of the effects of propofol and isoflurane anaesthesia on right ventricular function and shunt fraction during thoracic surgery","volume":"75","author":"Kellow","year":"1995","journal-title":"Br J Anaesth"},{"key":"R30-8-20240909","first-page":"929","article-title":"Effects of halothane, isoflurane, and propofol on venous admixture during one-lung ventilation in patients undergoing thoracoscopic procedures","volume":"5","author":"Gasowska","year":"1999","journal-title":"Med Sci Monit"},{"key":"R31-8-20240909","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/00000539-200104000-00010","article-title":"Thoracic epidural anesthesia combined with general anesthesia: The preferred anesthetic technique for thoracic surgery","volume":"92","author":"Von Dossow","year":"2001","journal-title":"Anesth Analg"},{"key":"R32-8-20240909","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/bja\/86.1.38","article-title":"Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery","volume":"86","author":"Beck","year":"2001","journal-title":"Br J Anaesth"},{"key":"R33-8-20240909","first-page":"233","article-title":"Haemodynamic and pulmonary shunt fraction changes with sevoflurane or propofol anaesthesia during one-lung ventilation for thoracic surgery","volume":"19","author":"El-Hakeem","year":"2003","journal-title":"Egypt J Anaesth"},{"key":"R34-8-20240909","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1111\/j.1399-6576.2007.01374.x","article-title":"Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation","volume":"51","author":"Ozcan","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"R35-8-20240909","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.ejcdt.2012.07.004","article-title":"Effects of thoracic epidural anesthesia on pulmonary venous admixture and oxygenation with isoflurane or propofol anesthesia during one lung ventilation","volume":"61","author":"Abdelrahman","year":"2012","journal-title":"Egyptian J Chest Dis Tuberc"},{"key":"R36-8-20240909","doi-asserted-by":"crossref","first-page":"799","DOI":"10.12669\/pjms.344.14585","article-title":"Effects of epidural anesthesia combined with inhalation anesthesia or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation","volume":"34","author":"Zheng","year":"2018","journal-title":"Pak J Med Sci"},{"key":"R37-8-20240909","first-page":"2423","article-title":"Analysis of comparative anesthetic effects of sevoflurane and propofol on lung and cognitive functions","volume":"32","author":"Zhiguo","year":"2019","journal-title":"Pak J Pharm Sci"},{"key":"R38-8-20240909","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/S1053-0770(96)80046-2","article-title":"A comparison of the effects of propofol-alfentanil versus isoflurane anesthesia on arterial oxygenation during one-lung ventilation","volume":"10","author":"Reid","year":"1996","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R39-8-20240909","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1093\/bja\/aem039","article-title":"Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation","volume":"98","author":"Pruszkowski","year":"2007","journal-title":"Br J Anaesth"},{"key":"R40-8-20240909","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1053\/j.jvca.2007.03.012","article-title":"Jugular bulb venous oxygen saturation during one-lung ventilation under sevoflurane- or propofol-based anesthesia for lung surgery","volume":"22","author":"Iwata","year":"2008","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R41-8-20240909","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1053\/j.jvca.2009.03.023","article-title":"The association between the initial end-tidal carbon dioxide difference and the lowest arterial oxygen tension value obtained during one-lung anesthesia with propofol or sevoflurane","volume":"23","author":"Fukuoka","year":"2009","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R42-8-20240909","first-page":"397","article-title":"Oxygenation during one-lung ventilation with propofol or sevoflurane","volume":"20","author":"Schwarzkopf","year":"2009","journal-title":"Middle East J Anaesthesiol"},{"key":"R43-8-20240909","doi-asserted-by":"crossref","first-page":"e15809","DOI":"10.5812\/ircmj.15809","article-title":"A comparison of effects of propofol and isoflurane on arterial oxygenation pressure, mean arterial pressure and heart rate variations following one-lung ventilation in thoracic surgeries","volume":"16","author":"Sharifian Attar","year":"2014","journal-title":"Iran Red Crescent Med J"},{"key":"R44-8-20240909","doi-asserted-by":"crossref","first-page":"6346","DOI":"10.19082\/6346","article-title":"Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: A double-blinded randomized controlled clinical trial","volume":"10","author":"Sheybani","year":"2018","journal-title":"Electron Physician"},{"key":"R45-8-20240909","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.3390\/jcm8091438","article-title":"Systemic oxygen delivery during one-lung ventilation: Comparison between propofol and sevoflurane anaesthesia in a randomised controlled trial","volume":"8","author":"Hahm","year":"2019","journal-title":"J Clin Med"},{"key":"R46-8-20240909","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12871-017-0302-x","article-title":"Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: A prospective randomized trial","volume":"17","author":"Cho","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"R47-8-20240909","doi-asserted-by":"crossref","first-page":"224","DOI":"10.4103\/sjamf.sjamf_43_18","article-title":"Effects of volatile versus intravenous anesthesia on oxygenation and hemodynamic response during thoracotomy with one-lung ventilation","volume":"2","author":"Mohamed","year":"2018","journal-title":"Sci J Al-Azhar Med Fac Girls"},{"key":"R48-8-20240909","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/ALN.0000000000000569","article-title":"Hypoxic pulmonary vasoconstriction: Physiology and anesthetic implications","volume":"122","author":"Lumb","year":"2015","journal-title":"Anesthesiology"},{"key":"R49-8-20240909","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/00000542-198404000-00006","article-title":"Effects of halothane, enflurane, and isoflurane on hypoxic pulmonary vasoconstriction in rat lungs in vitro","volume":"60","author":"Marshall","year":"1984","journal-title":"Anesthesiology"},{"key":"R50-8-20240909","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1093\/bja\/81.6.850","article-title":"Comparison of the effects of sevoflurane and isoflurane on arterial oxygenation during one lung ventilation","volume":"81","author":"Wang","year":"1998","journal-title":"Br J Anaesth"},{"key":"R51-8-20240909","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1213\/00000539-199810000-00011","article-title":"Desflurane and isoflurane produce similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing one-lung ventilation during thoracotomy","volume":"87","author":"Pagel","year":"1998","journal-title":"Anesth Analg"},{"key":"R52-8-20240909","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/0952-8180(89)90028-7","article-title":"Propofol does not inhibit hypoxic pulmonary vasoconstriction in humans","volume":"1","author":"Van Keer","year":"1989","journal-title":"J Clin Anesth"},{"key":"R53-8-20240909","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12871-015-0107-8","article-title":"Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery","volume":"15","author":"Li","year":"2015","journal-title":"BMC Anesthesiol"},{"key":"R54-8-20240909","first-page":"242709","article-title":"Impact of volatile anesthetics on oxidative stress and inflammation?","volume":"2015","author":"Lee","year":"2015","journal-title":"Biomed Res Int"},{"key":"R55-8-20240909","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1093\/bja\/aes469","article-title":"Sevoflurane suppresses tumour necrosis factor-alpha-induced inflammatory responses in small airway epithelial cells after anoxia\/reoxygenation","volume":"110","author":"Watanabe","year":"2013","journal-title":"Br J Anaesth"},{"key":"R56-8-20240909","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1213\/ANE.0000000000001296","article-title":"Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury","volume":"123","author":"Strosing","year":"2016","journal-title":"Anesth Analg"},{"key":"R57-8-20240909","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/00000539-200110000-00036","article-title":"Oxidative stress status during exposure to propofol, sevoflurane and desflurane","volume":"93","author":"Allaouchiche","year":"2001","journal-title":"Anesth Analg"},{"key":"R58-8-20240909","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/j.1399-6576.2005.00677.x","article-title":"Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgery","volume":"49","author":"Koksal","year":"2005","journal-title":"Acta Anaesthesiol Scand"},{"key":"R59-8-20240909","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1164\/ajrccm.156.4.9610002","article-title":"The systemic inflammatory response in the development of ventilator- associated pneumonia","volume":"156","author":"Bonten","year":"1997","journal-title":"Am J Respir Crit Care Med"},{"key":"R60-8-20240909","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/S1471-4892(01)00043-1","article-title":"Interleukin-8 receptor antagonists in pulmonary diseases","volume":"1","author":"Hay","year":"2001","journal-title":"Curr Opin Pharmacol"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_1106_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:18:31Z","timestamp":1787843911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_1106_20"}},"subtitle":["A narrative review"],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":60,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_1106_20","relation":{},"ISSN":["1658-354X"],"issn-type":[{"value":"1658-354X","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}