Discussion
ADVERSE EFFECTS, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
In this randomised clinical trial involving adults undergoing thoracoscopic surgery, preoperative prophylactic inhalation of penehyclidine did not significantly reduce the driving pressure and mechanical power during OLV compared with intravenous administration. Moreover, there was no observed reduction in PPCs within the first 7 days postoperatively.Preliminary studies have established an association between increased driving pressure and an augmented risk of complications and mortality [Previous retrospective studies have drawn attention to a concerning connection between the excessive application of mechanical power during surgery and an increased risk of postoperative complications [Penehyclidine, a novel anticholinergic drug, specifically targets M1 and M3 receptors and achieves peak plasma concentration around 0.56 h after administration [Nebulised drug inhalation delivers the drug directly to the airway, resulting in a higher local concentration and faster onset of action, with fewer systemic adverse effects. However, the absence of a significant difference between the inhaled and intravenous groups in our study might be attributed to the inhalation technique employed and the drug’s blood concentration. Further research should focus on determining the optimal dosage and inhalation method for nebulised drugs.There are several limitations to this study. First, the absence of a placebo-controlled trial to demonstrate the effectiveness of penehyclidine on driving pressure and mechanical power is notable. This limitation stems from the requirement of routine anticholinergic administration during thoracic surgery to manage secretions. Second, our inability to determine the blood concentration and peak time after penehyclidine inhalation posed challenges in aligning the duration of action with intravenous administration. Third, this study concentrated on determining the driving pressure and mechanical power during OLV, however, it did not factor in the respiratory mechanics during two-lung ventilation, which could influence the reliability of the research results. Fourth, wedge resection has been found to have a low rate of PPCs in thoracic surgery [