Effect of anesthetic choice on perioperative inflammatory markers and postoperative pulmonary infections in cardiac surgery patients.

Abstract

Objective: To evaluate whether specific anesthetic selection significantly impacts perioperative systemic inflammatory responses and subsequent postoperative pulmonary infections in adult patients undergoing cardiac surgical procedures. Study Design: Cross Sectional study. Period: November 2025 to April 2026. Setting: Sahiwal Institute of Cardiology, Sahiwal. Methods: Total of 120 adult patients undergoing elective cardiopulmonary bypass cardiac surgery was evaluated. The patients were divided into two equal groups, allocating 60 to inhalational sevoflurane and 60 to propofol-based total intravenous anesthesia. We measured C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and procalcitonin preoperatively, immediately postoperatively, and at 24 hours. Additionally pulmonary infections, mechanical ventilation duration, intensive care and hospital lengths of stay and overall mortality were monitored. Results: Baseline demographic and clinical characteristics were comparable. Postoperative inflammatory markers significantly elevated in both groups; however, the sevoflurane group exhibited significantly lower C-reactive protein, interleukin-6, tumor necrosis factor-alpha and procalcitonin levels compared to the propofol. Pulmonary infection rates were significantly reduced with sevoflurane administration versus propofol. Moreover, the sevoflurane group experienced significantly shortened mechanical ventilation duration, intensive care unit stays, and total hospital lengths of stay, while in-hospital mortality remained statistically equivalent between both patient study groups. Conclusion: Compared to propofol-based total intravenous anesthesia, sevoflurane significantly attenuates perioperative systemic inflammation, decreases pulmonary infection incidence, and accelerates overall postoperative recovery. Anesthetic selection is crucial for optimizing perioperative outcomes and minimizing postoperative clinical complications in this specific patient population.