• Stephanie D Grabitz, Hassan N Farhan, Katarina J Ruscic, Fanny P Timm, Christina H Shin, Tharusan Thevathasan, Anne K Staehr-Rye, Tobias Kurth, and Matthias Eikermann.
• 1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA. 2Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Herlev, Denmark. 3Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany. 4Klinik für Anästhesiologie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany.
• Crit. Care Med. 2017 Jan 1; 45 (1): e30-e39.

ObjectivesInhalational anesthetics are bronchodilators with immunomodulatory effects. We sought to determine the effect of inhalational anesthetic dose on risk of severe postoperative respiratory complications.DesignProspective analysis of data on file in surgical cases between January 2007 and December 2015.SettingMassachusetts General Hospital (tertiary referral center) and two affiliated community hospitals.PatientsA total of 124,497 adult patients (105,267 in the study cohort and 19,230 in the validation cohort) undergoing noncardiac surgical procedures and requiring general anesthesia with endotracheal intubation.InterventionsMedian effective dose equivalent of inhalational anesthetics during surgery (derived from mean end-tidal inhalational anesthetic concentrations).Measurements And Main ResultsPostoperative respiratory complications occurred in 6,979 of 124,497 cases (5.61%). High inhalational anesthetic dose of 1.20 (1.13-1.30) (median [interquartile range])-fold median effective dose equivalent versus 0.57 (0.45-0.64)-fold median effective dose equivalent was associated with lower odds of postoperative respiratory complications (odds ratio, 0.59; 95% CI, 0.53-0.65; p < 0.001). Additionally, high inhalational anesthetic dose was associated with lower 30-day mortality and lower cost. Inhalational anesthetic dose increase and reduced risk of postoperative respiratory complications remained significant in sensitivity analyses stratified by preoperative and intraoperative risk factors.ConclusionsIntraoperative use of higher inhalational anesthetic doses is strongly associated with lower odds of postoperative respiratory complications, lower 30-day mortality, and lower cost of hospital care. The authors speculate based on these data that sedation with inhalational anesthetics outside of the operating room may likewise have protective effects that decrease the risk of respiratory complications in vulnerable patients.

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