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Anti-inflammatory action of sevoflurane in lung surgery with one lung ventilation

Background

In patients undergoing lung surgery mechanical ventilation and surgical trauma may induce alveolar and systemic inflammatory response. One-lung ventilation (OLV) has become as a standard procedure in thoracic surgery. It is also the main cause of acute inflammatory response and is associated with ALI and ARDS.

Demonstrating the influence of volatile anaesthetics on the inflammatory response and the treatment outcome in patients undergoing lung surgery with one lung ventilation (OLV) is still a great challenge.

The effects of sevoflurane on local release of inflammatory cytokines has been shown before. The added value of our study is that the systemic immunomodulatory effect of sevoflurane, postoperative clinical outcome and complications were tested.

The aim of the study was to prospectively investigate the systemic anti-inflammatory effect of the volatile anaesthetic sevoflurane in patients undergoing lung surgery with OLV.

Key words: one-lung ventilation, sevoflurane, inflammation

Methods

Forty patients undergoing thoracic surgery with OLV were enrolled in this prospective, randomized study. The patients were randomly allocated into two groups to receive either propofol (Group P) or sevoflurane (Group S).

Anaesthesia was induced and maintained with propofol (Group P) and with sevoflurane (Group S). In addition, both groups received remifentanil 0.5-1 μg/kg and vecuronium 0.1 mg/kg.  After intubation with a double-lumen tube, the lungs were ventilated mechanically with oxygen-air mixtures.

Inflammatory mediators (interleukin 6 (IL6), interleukin (IL8), interleukin 10 (IL10), C-reactive protein (CRP) and procalcitonin (PCT)) were measured intra- and postoperatively.

Six hours after surgery, chest X rays were taken and the infiltration of the nonoperated lung assessed (0: clear, 1: partly inflamed, 2: totally inflamed) and the oxigenation index (arterial oxygen tension to fraction of inspired oxygen ratio= pO2 / FiO2) was calculated.

The clinical outcome determinated by postoperative major complications was assessed as the secondary endpoint.

Results

Inflammatory cytokines (IL 6 and IL 8) were more elevated in Group P than in Group S. The most prominent difference between Group P and group S was seen in the levels of the main proinflammatory cytokine IL 6 (p=0.014). The increase of proinflammatory cytokine IL 8 concentration was higher in Group P, yet the difference between the groups was not statistically significant (p=0.074). The increase of anti-inflammatory cytokine IL 10 levels was more pronounced in Group S, but the difference between the groups was not statistically significant (p=0.978).

Preoperative CRP levels were not significantly different between the groups and were in all patients lower than 20 mg/L; preoperative PCT was in the normal range, lower than 0.04 mcg/L in both groups. Postoperative CRP was higher in P group than in S group (31±6 vs 15±7 mg/L; p=0.03); postoperative PCT was in the normal range in both groups (<0.04 mcg/L)The oxygenation index 6 h after the surgery was lower in Group P compared to Group S (339±139 vs. 465±140; p = 0.02), the same was also after 24h after the surgery (320±122 vs. 450±175; p=0.019. Postoperative X rays showed no significant difference in lung infiltrates between Group S and Group P (p=0.58). The number of postoperative adverse events was significantly higher in the Group P (15 vs 6; p<0.05).

Conclusion

This study suggests an anti-inflammatory effect of sevoflurane in patients undergoing lung surgery with OLV.

References

  1. Potocnik I., Novak-Jankovic V., Sostaric M., Jerin A., Stupnik T., Skitek M., Markovic- Bozi J., Klokocovnik T.;Anti-inflammatory effect of sevoflurane in open lung surgery with one-lung ventilation. Croatian medical journal, ISSN 0353-9504, 2014, vol. 55, iss. 6, str. 628-637. http://www.cmj.hr/default.aspx?id=12405&issue=yes

 

Iztok Potocnik, MD, PHD
prof. Vesna Novak-Jankovic, MD, PHD
University Medical Centre Ljubljana, Clinical Department for Anaesthesiology and Intensive Therapy

Tomaz Stupnik, MD
University Medical Centre Ljubljana, Clinical Department for Thoracic Surgery

Corresponding author's contact: iztok.potocnik@kclj.si

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