Oxidative Stress Effects of TIVA, CIVA, and Balanced Anesthesia in VATS

NCT07271472 | Recruiting

• 1 other identifier: ATAUNIVATS
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The primary objective of our study is to compare the effects of total intravenous anesthesia (TIVA), combined intravenous-volatile anesthesia (CIVA), and balanced anesthesia (BAL) methods on perioperative oxidative stress parameters, such as Malondialdehyde (MDA), Total Oxidant Status (TOS), Total Antioxidant Status (TAS), and Superoxide Dismutase (SOD), in patients undergoing video-assisted thoracoscopic surgery (VATS). The secondary objective is to record perioperative vital parameters, arterial blood gas values obtained at specific stages of the surgery, and the incidence of postoperative nausea and vomiting (PONV).

Conditions

VATS; Video Assisted Thoracoscopic Surgery

Keywords

Video-Assisted Thoracoscopic Surgery; Total Intravenous Anesthesia; Combined Intravenous Volatile Anesthesia; Balanced Anesthesia; Malondialdehyde; Total Oxidant Status; Total Antioxidant Status; Superoxide Dismutase

Outcome Measures

Primary Outcomes (4)

• Malondialdehyde levels in perioperatively collected blood samples

  For measurement of this marker, arterial blood samples will be collected from the radial artery at three time points: immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation. The collected blood samples will be centrifuged at +4 °C at 4500 rpm for 7 minutes. The obtained serum samples will be transferred into Eppendorf tubes and stored at -80 °C until the day of analysis. Serum levels of MDA will be measured using the ELISA method.

  Immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation

• Total Antioxidant Status levels in perioperatively collected blood samples

  For measurement of this marker, arterial blood samples will be collected from the radial artery at three time points: immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation. The collected blood samples will be centrifuged at +4 °C at 4500 rpm for 7 minutes. The obtained serum samples will be transferred into Eppendorf tubes and stored at -80 °C until the day of analysis. Serum levels of TAS will be measured using the ELISA method.

  Immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation

• Total Oxidant Status levels in perioperatively collected blood samples

  For measurement of this marker, arterial blood samples will be collected from the radial artery at three time points: immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation. The collected blood samples will be centrifuged at +4 °C at 4500 rpm for 7 minutes. The obtained serum samples will be transferred into Eppendorf tubes and stored at -80 °C until the day of analysis. Serum levels of TOS will be measured using the ELISA method.

  Immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation

• Superoxide Dismutase levels in perioperatively collected blood samples

  For measurement of this marker, arterial blood samples will be collected from the radial artery at three time points: immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation. The collected blood samples will be centrifuged at +4 °C at 4500 rpm for 7 minutes. The obtained serum samples will be transferred into Eppendorf tubes and stored at -80 °C until the day of analysis. Serum levels of SOD will be measured using the ELISA method.

  Immediately before anesthesia induction, before the transition from one-lung ventilation to two-lung ventilation, and 30 minutes after the re-establishment of two-lung ventilation

Secondary Outcomes (3)

• Postoperative nausea and vomiting

  From 1 to 24 hour post operatively

• Partial pressure of oxygen (PaO₂) values

  During anesthesia induction, at 15, 30, 45, and 60 minutes of one-lung ventilation, and 30 minutes after the transition to two-lung ventilation

• Partial pressure of carbon dioxide pressure (PaCO₂)

  During anesthesia induction, at 15, 30, 45, and 60 minutes of one-lung ventilation, and 30 minutes after the transition to two-lung ventilation

Study Arms (3)

Total Intravenous Anesthesia (TIVA) Group

EXPERIMENTAL

Anesthesia induction will include 2 mg midazolam, 2-2.5 mg/kg propofol, 0.6-0.9 mg/kg rocuronium, and 1 μg/kg remifentanil. Maintenance will be provided with target-controlled infusion (TCI) propofol at a Ce of 4-6 μg/mL and TCI remifentanil at a Ce of 1.5-3 ng/mL while maintaining the bispectral index (BIS) between 40-60.

Drug: Total Intravenous Anesthesia (TIVA) Group

Balanced Anesthesia (BAL) Group

EXPERIMENTAL

Induction will follow the same protocol as the TIVA group. During maintenance, desflurane 5-7% (MAC 1-1.3) and TCI remifentanil at a Ce of 1.5-3 ng/mL will be administered, targeting a BIS value between 40-60.

Drug: Balanced Anesthesia (BAL) Group

Combined Intravenous Volatile Anesthesia (CIVA) Group

EXPERIMENTAL

Induction will follow the same protocol as other groups. Maintenance will include TCI propofol at a Ce of 2-4 μg/mL and TCI remifentanil at a Ce of 1.5-3 ng/mL along with 3% desflurane (MAC 0.5), keeping BIS values between 40-60.

Drug: Combined Intravenous Volatile Anesthesia

Interventions

Total Intravenous Anesthesia (TIVA) Group DRUG

Anesthesia induction will include 2 mg midazolam, 2-2.5 mg/kg propofol, 0.6-0.9 mg/kg rocuronium, and 1 μg/kg remifentanil. Maintenance will be provided with target-controlled infusion (TCI) propofol at a Ce of 4-6 μg/mL and TCI remifentanil at a Ce of 1.5-3 ng/mL while maintaining the bispectral index (BIS) between 40-60.

Also known as: TIVA Group

Total Intravenous Anesthesia (TIVA) Group

Balanced Anesthesia (BAL) Group DRUG

Induction will follow the same protocol as the TIVA group. During maintenance, desflurane 5-7% (MAC 1-1.3) and TCI remifentanil at a Ce of 1.5-3 ng/mL will be administered, targeting a BIS value between 40-60.

Also known as: BAL Group

Balanced Anesthesia (BAL) Group

Combined Intravenous Volatile Anesthesia DRUG

Induction will follow the same protocol as other groups. Maintenance will include TCI propofol at a Ce of 2-4 μg/mL and TCI remifentanil at a Ce of 1.5-3 ng/mL along with 3% desflurane (MAC 0.5), keeping BIS values between 40-60.

Also known as: CIVA Group

Combined Intravenous Volatile Anesthesia (CIVA) Group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged between 18 and 65 years,
• American Society of Anesthesiologists (ASA) Physical Status Class I-II,
• Scheduled for elective Video-Assisted Thoracoscopic Surgery (VATS)
• Requiring one-lung ventilation for more than 60 minutes

You may not qualify if:

• Refusal to participate in the study
• History of allergy to the drugs to be used
• Recent history of vitamin supplementation
• History of severe cardiac, renal, or hepatic disease
• ASA III-IV

Sponsors & Collaborators

• Ataturk University: lead

Study Sites (1)

Ataturk University

Erzurum, 25000, Turkey (Türkiye)

RECRUITING

Related Publications (11)

• Comhair SA, Erzurum SC. Antioxidant responses to oxidant-mediated lung diseases. Am J Physiol Lung Cell Mol Physiol. 2002 Aug;283(2):L246-55. doi: 10.1152/ajplung.00491.2001.

  PMID: 12114185 RESULT

• Lang JD, McArdle PJ, O'Reilly PJ, Matalon S. Oxidant-antioxidant balance in acute lung injury. Chest. 2002 Dec;122(6 Suppl):314S-320S. doi: 10.1378/chest.122.6_suppl.314s.

  PMID: 12475808 RESULT

• Cheng YJ, Chan KC, Chien CT, Sun WZ, Lin CJ. Oxidative stress during 1-lung ventilation. J Thorac Cardiovasc Surg. 2006 Sep;132(3):513-8. doi: 10.1016/j.jtcvs.2006.03.060.

  PMID: 16935103 RESULT

• Sharifian Attar A, Tabari M, Rahnamazadeh M, Salehi M. 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. Iran Red Crescent Med J. 2014 Feb;16(2):e15809. doi: 10.5812/ircmj.15809. Epub 2014 Feb 8.

  PMID: 24719749 RESULT

• Xu WY, Wang N, Xu HT, Yuan HB, Sun HJ, Dun CL, Zhou SQ, Zou Z, Shi XY. Effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients undergone esophagectomy. Int J Clin Exp Pathol. 2013 Dec 15;7(1):272-9. eCollection 2014.

  PMID: 24427348 RESULT

• Schwarzkopf K, Schreiber T, Preussler NP, Gaser E, Huter L, Bauer R, Schubert H, Karzai W. Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Cardiothorac Vasc Anesth. 2003 Feb;17(1):73-5. doi: 10.1053/jcan.2003.13.

  PMID: 12635064 RESULT

• Loer SA, Scheeren TW, Tarnow J. Desflurane inhibits hypoxic pulmonary vasoconstriction in isolated rabbit lungs. Anesthesiology. 1995 Sep;83(3):552-6. doi: 10.1097/00000542-199509000-00014.

  PMID: 7661356 RESULT

• Karzai W, Haberstroh J, Priebe HJ. Effects of desflurane and propofol on arterial oxygenation during one-lung ventilation in the pig. Acta Anaesthesiol Scand. 1998 Jul;42(6):648-52. doi: 10.1111/j.1399-6576.1998.tb05296.x.

  PMID: 9689269 RESULT

• Eisenkraft JB. Effects of anaesthetics on the pulmonary circulation. Br J Anaesth. 1990 Jul;65(1):63-78. doi: 10.1093/bja/65.1.63. No abstract available.

  PMID: 2200486 RESULT

• Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015 Apr;122(4):932-46. doi: 10.1097/ALN.0000000000000569.

  PMID: 25587641 RESULT

• Dunham-Snary KJ, Wu D, Sykes EA, Thakrar A, Parlow LRG, Mewburn JD, Parlow JL, Archer SL. Hypoxic Pulmonary Vasoconstriction: From Molecular Mechanisms to Medicine. Chest. 2017 Jan;151(1):181-192. doi: 10.1016/j.chest.2016.09.001. Epub 2016 Sep 16.

  PMID: 27645688 RESULT

MeSH Terms

Interventions

Population Groups; Balanced Anesthesia

Intervention Hierarchy (Ancestors)

Demography; Population Characteristics; Anesthesia, General; Anesthesia; Anesthesia and Analgesia

Study Officials

• Elif Oral Ahiskalioglu, Professor

  Ataturk University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Elif Oral Ahiskalioglu, Professor

CONTACT

+90-505-925-96-32; drelforl@hotmail.com

Mehmet Z Guney, MD

CONTACT

+90-541-718-34-25; gnyzbyr@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: November 25, 2025
• First Posted: December 9, 2025
• Study Start: December 1, 2025
• Primary Completion: May 1, 2026
• Study Completion: May 2, 2026
• Last Updated: January 5, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)