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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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

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Targeting the Endocannabinoid System to Treat Sepsis

Abstract

The endocannabinoid system represents a potential therapeutic target in sepsis due to the presence of cannabinoid receptors (CB2) on immune cells. In this review we discuss how various targets within the endocannabinoid system can be manipulated to treat the immune consequences of sepsis. One of the targets outlined are the endocannabinoid receptors and modulation of their activity through pharmacological agonists and antagonists. Another therapeutic target covered in this review is the modulation of the endocannabinoid degradative enzyme’s activity. Modulation of degradative enzyme activity can change the levels of endogenous cannabinoids thereby altering immune activity. Overall, activation of the CB2 receptors causes immunosuppression and can be beneficial during the hyperactivated immune state of sepsis, while suppression of the CB2 receptors may be beneficial during a hypoimmune septic state.

Key words: sepsis, endocannabinoid system, inflammation, immune modulation

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