| Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients. | |
| | |
MedLine Citation:
|
PMID: 21399490 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: One-lung ventilation (OLV) results in alveolar proinflammatory effects, whereas their extent may depend on administration of anesthetic drugs. The current study evaluates the effects of different volatile anesthetics compared with an intravenous anesthetic and the relationship between pulmonary and systemic inflammation in patients undergoing open thoracic surgery. METHODS: Sixty-three patients scheduled for elective open thoracic surgery were randomized to receive anesthesia with 4 mg · kg⁻¹ · h⁻¹ propofol (n = 21), 1 minimum alveolar concentration desflurane (n = 21), or 1 minimum alveolar concentration sevoflurane (n = 21). Analgesia was provided by remifentanil (0.25 μg · kg⁻¹ · min⁻¹). After intubation, all patients received pressure-controlled mechanical ventilation with a tidal volume of approximately 7 ml · kg ideal body weight, a peak airway pressure lower than 30 cm H₂O, a respiratory rate adjusted to a Paco2 of 40 mmHg, and a fraction of inspired oxygen lower than 0.8 during OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed immediately after intubation and after surgery. The expression of inflammatory cytokines was determined in the lavage fluids and serum samples by multiplexed bead-based immunoassays. RESULTS: Proinflammatory cytokines increased in the ventilated lung after OLV. Mediator release was more enhanced during propofol anesthesia compared with desflurane or sevoflurane administration. For tumor necrosis factor-α, the values were as follows: propofol, 5.7 (8.6); desflurane, 1.6 (0.6); and sevoflurane, 1.6 (0.7). For interleukin-8, the values were as follows: propofol, 924 (1680); desflurane, 390 (813); and sevoflurane, 412 (410). (Values are given as median [interquartile range] pg · ml⁻¹). Interleukin-1β was similarly reduced during volatile anesthesia. The postoperative serum interleukin-6 concentration was increased in all patients, whereas the systemic proinflammatory response was negligible. CONCLUSIONS: OLV increases the alveolar concentrations of proinflammatory mediators in the ventilated lung. Both desflurane and sevoflurane suppress the local alveolar, but not the systemic, inflammatory responses to OLV and thoracic surgery. |
| | |
Authors:
|
Thomas Schilling; Alf Kozian; Mert Senturk; Christof Huth; Annegret Reinhold; Göran Hedenstierna; Thomas Hachenberg |
Publication Detail:
|
Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
|
Title: Anesthesiology Volume: 115 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2011 Jul |
Date Detail:
|
Created Date: 2011-06-23 Completed Date: 2011-08-23 Revised Date: 2012-02-29 |
Medline Journal Info:
|
Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
|
Languages: eng Pagination: 65-74 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. thomas.schilling@med.ovgu.de |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Airway Management / adverse effects Anesthesia, General Anesthesia, Inhalation* Anesthesia, Intravenous* Bronchoalveolar Lavage Fluid Cytokines / blood, metabolism Female Hemodynamics / drug effects Humans Inflammation / physiopathology* Isoflurane / analogs & derivatives Male Methyl Ethers Middle Aged Monitoring, Intraoperative Oxygen / blood Perioperative Period Propofol Respiration, Artificial / methods Respiratory Function Tests Thoracic Surgical Procedures* Young Adult |
| Chemical | |
Reg. No./Substance:
|
0/Cytokines; 0/Methyl Ethers; 2078-54-8/Propofol; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 57041-67-5/desflurane; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
|
Anesthesiology. 2012 Feb;116(2):492; author reply 492-3
[PMID:
22273867
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Distinctive Immunohistochemical Profile of Penile Intraepithelial Lesions: A Study of 74 Cases.
Next Document: Inhibition of polo-like kinase 1 leads to the suppression of osteosarcoma cell growth in vitro and i...