Document Detail


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
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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


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