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01-02-2012 | Original Article

Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection

Authors: Yusuke Sugasawa, Keisuke Yamaguchi, Seiichiro Kumakura, Taisuke Murakami, Kenji Suzuki, Isao Nagaoka, Eiichi Inada

Published in: Journal of Anesthesia | Issue 1/2012

Abstract

Purpose

Pulmonary inflammatory reactions are affected by one-lung ventilation (OLV) and anesthetic agents. However, the effects of anesthetic agents on pulmonary inflammatory reactions may vary. Our previous investigations suggested that inflammatory reactions were more pronounced in the dependent lung during lung resection under general anesthesia with propofol and remifentanil. Therefore, in the present study we attempted to determine the difference in pulmonary inflammatory reaction using either sevoflurane or propofol in both dependent and nondependent lungs during OLV.

Methods

Forty adult patients undergoing elective lung resection were randomized to receive either propofol (n = 20) or sevoflurane (n = 20) as the main anesthetic agent. Intraoperative analgesia was provided by remifentanil in both groups. Epithelial lining fluid (ELF) was obtained from each lung using a bronchoscopic microsampling method. ELF and plasma levels of inflammatory cytokines were measured using multiplexed bead-based immunoassays before and after OLV.

Results

Epithelial lining fluid levels of interleukin (IL)-1β, IL-6, and IL-8 were significantly increased in the dependent lung and the nondependent lung after OLV compared with baseline levels (P < 0.05). Moreover, IL-6 ELF level in the dependent lung was significantly higher in the propofol group than in the sevoflurane group after OLV (P < 0.001).

Conclusion

One-lung ventilation induced inflammatory responses of the bronchial epithelia in the dependent lung and the nondependent lung during lung resection. Moreover, this inflammatory response was significantly suppressed by sevoflurane compared with propofol. Furthermore, the antiinflammatory effect of sevoflurane was more pronounced in the dependent lung than in the nondependent lung during OLV.

Yamaguchi K, Sugasawa Y, Takeuchi K, Kugimiya T, Kumakura S, Iwanuma Y, Kajiyama Y, Tsurumaru M, Nagaoka I, Inada E. Effects of sivelestat on bronchial inflammatory responses after esophagectomy. Int J Mol Med. 2011;28:187–92.PubMed

De Conno E, Steurer M, Wittlinger M, Zalunardo M, Weder W, Schneiter D, Schimmer R, Klaghofer R, Neff T, Schmid E, Spahn D, Z’graggen B, Urner M, Beck-Schimmer B. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.CrossRefPubMed

D’Journo X, Michelet P, Marin V, Diesnis I, Blayac D, Doddoli C, Bongrand P, Thomas P. An early inflammatory response to oesophagectomy predicts the occurrence of pulmonary complications. Eur J Cardiothorac Surg. 2010;37:1144–51.CrossRefPubMed

Michelet P, D’Journo X, Roch A, Doddoli C, Marin V, Papazian L, Decamps I, Bregeon F, Thomas P, Auffray J. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology. 2006;105:911–9.CrossRefPubMed

Baudouin S. Lung injury after thoracotomy. Br J Anaesth. 2003;91:132–42.CrossRefPubMed

Sugasawa Y, Yamaguchi K, Kumakura S, Murakami T, Kugimiya T, Suzuki K, Nagaoka I, Inada E. The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection. J Anesth. 2011;25:170–7.CrossRefPubMed

Schilling T, Kozian A, Huth C, Bühling F, Kretzschmar M, Welte T, Hachenberg T. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg. 2005;101:957–65.CrossRefPubMed

Fernández-Pérez E, Keegan M, Brown D, Hubmayr R, Gajic O. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology. 2006;105:14–8.CrossRefPubMed

von Bethmann A, Brasch F, Nüsing R, Vogt K, Volk H, Müller K, Wendel A, Uhlig S. Hyperventilation induces release of cytokines from perfused mouse lung. Am J Respir Crit Care Med. 1998;157:263–72.CrossRef

10.

Madjdpour C, Oertli B, Ziegler U, Bonvini J, Pasch T, Beck-Schimmer B. Lipopolysaccharide induces functional ICAM-1 expression in rat alveolar epithelial cells in vitro. Am J Physiol Lung Cell Mol Physiol. 2000;278:572–9.

11.

Voigtsberger S, Lachmann R, Leutert A, Schläpfer M, Booy C, Reyes L, Urner M, Schild J, Schimmer R, Beck-Schimmer B. Sevoflurane ameliorates gas exchange and attenuates lung damage in experimental lipopolysaccharide-induced lung injury. Anesthesiology. 2009;111:1238–48.CrossRefPubMed

12.

Sheeran P, Hall GM. Cytokines in anaesthesia. Br J Anaesth. 1997;78:201–19.CrossRefPubMed

13.

Bless NM, Huber-Lang M, Guo RF, Warner RL, Schmal H, Czermak BJ, Shanley TP, Crouch LD, Lentsch AB, Sarma V, Mulligan MS, Friedl HP, Ward PA. Role of CC chemokines (macrophage inflammatory protein-1 beta, monocyte chemoattractant protein-1, RANTES) in acute lung injury in rats. J Immunol. 2000;164:2650–9.CrossRefPubMed

14.

Beck-Schimmer B, Schwendener R, Pasch T, Reyes L, Booy C, Schimmer RC. Alveolar macrophages regulate neutrophil recruitment in endotoxin-induced lung injury. Respir Res. 2005;6:61.CrossRefPubMedPubMedCentral

15.

Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Bühling F, Hedenstierna G, Hachenberg T. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth. 2007;99:368–75.CrossRefPubMed

16.

Schilling T, Kozian A, Senturk M, Huth C, Reinhold A, Hedenstierna G, Hachenberg T. Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients. Anesthesiology. 2011;115:65–74.CrossRefPubMed

17.

Ishizaka A, Watanabe M, Yamashita T, Ogawa Y, Koh H, Hasegawa N, Nakamura H, Asano K, Yamaguchi K, Kotani M, Kotani T, Morisaki H, Takeda J, Kobayashi K, Ogawa S. New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome. Crit Care Med. 2001;29:896–8.CrossRefPubMed

18.

Slutsky AS. Lung injury caused by mechanical ventilation. Chest. 1999;116:9–15.CrossRef

19.

Halliwell B. Reactive oxygen species in living systems: source, biochemistry, and role in human disease. Am J Med. 1991;91:14–22.CrossRef

20.

Clark J. Pulmonary limits of oxygen tolerance in man. Exp Lung Res. 1988;14:897–910.CrossRefPubMed

21.

Whitehead T, Slutsky A. The pulmonary physician in critical care: ventilator induced lung injury. Thorax. 2002;57:635–42.CrossRefPubMedPubMedCentral

22.

Kozian A, Schilling T, Fredén F, Maripuu E, Röcken C, Strang C, Hachenberg T, Hedenstierna G. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study. Br J Anaesth. 2008;100:549–59.CrossRefPubMed

23.

Kozian A, Schilling T, Schütze H, Heres F, Hachenberg T, Hedenstierna G. Lung computed tomography density distribution in a porcine model of one-lung ventilation. Br J Anaesth. 2009;102:551–60.CrossRefPubMed

24.

Wolthuis E, Choi G, Dessing M, Bresser P, Lutter R, Dzoljic M, van der Poll T, Vroom M, Hollmann M, Schultz M. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108:46–54.CrossRefPubMed

25.

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342:1301–8.

26.

Funakoshi T, Ishibe Y, Okazaki N, Miura K, Liu R, Nagai S, Minami Y. Effect of re-expansion after short-period lung collapse on pulmonary capillary permeability and pro-inflammatory cytokine gene expression in isolated rabbit lungs. Br J Anaesth. 2004;92:558–63.CrossRefPubMed

27.

De Leyn P, Schreinemakers H, Van Raemdonck D, Mubagwa K, Flameng W. Effect of inflation on adenosine triphosphate catabolism and lactate production during normothermic lung ischemia. Ann Thorac Surg. 1993;55:1073–8. (discussion 1079).CrossRefPubMed

28.

Hamvas A, Park C, Palazzo R, Liptay M, Cooper J, Schuster D. Modifying pulmonary ischemia–reperfusion injury by altering ventilatory strategies during ischemia. J Appl Physiol. 1992;73:2112–9.PubMed

29.

Madjdpour C, Jewell U, Kneller S, Ziegler U, Schwendener R, Booy C, Kläusli L, Pasch T, Schimmer R, Beck-Schimmer B. Decreased alveolar oxygen induces lung inflammation. Am J Physiol Lung Cell Mol Physiol. 2003;284:360–7.CrossRef

30.

Tekinbas C, Ulusoy H, Yulug E, Erol M, Alver A, Yenilmez E, Geze S, Topbas M. One-lung ventilation: for how long? J Thorac Cardiovasc Surg. 2007;134:405–10.CrossRefPubMed

31.

Wrigge H, Zinserling J, Stüber F, von Spiegel T, Hering R, Wetegrove S, Hoeft A, Putensen C. Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology. 2000;93:1413–7.CrossRefPubMed

32.

Puls A, Pollok-Kopp B, Wrigge H, Quintel M, Neumann P. Effects of a single-lung recruitment maneuver on the systemic release of inflammatory mediators. Intensive Care Med. 2006;32:1080–5.CrossRefPubMed

33.

Talmor D, Sarge T, Legedza A, O’Donnell CR, Ritz R, Loring SH, Malhotra A. Cytokine release following recruitment maneuvers. Chest. 2007;132:1434–9.CrossRefPubMedPubMedCentral

34.

Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63.CrossRefPubMed

35.

Suter D, Spahn DR, Blumenthal S, Reyes L, Booy C, Z’graggen BR, Beck-Schimmer B. The immunomodulatory effect of sevoflurane in endotoxin-injured alveolar epithelial cells. Anesth Analg. 2007;104:638–45.CrossRefPubMed

36.

Steurer M, Schläpfer M, Z’graggen BR, Booy C, Reyes L, Spahn DR, Beck-Schimmer B. The volatile anaesthetic sevoflurane attenuates lipopolysaccharide-induced injury in alveolar macrophages. Clin Exp Immunol. 2009;155:224–30.CrossRefPubMedPubMedCentral

37.

Takala RS, Soukka H, Salo MS, Kirvelä O, Kääpä P, Aantaa R. Gene expression of pulmonary cytokines after sevoflurane or thiopentone anaesthesia in pigs. Acta Anaesthesiol Scand. 2006;50:163–7.CrossRefPubMed

38.

Tschaikowsky K, Ritter J, Schröppel K, Kühn M. Volatile anesthetics differentially affect immunostimulated expression of inducible nitric oxide synthase: role of intracellular calcium. Anesthesiology. 2000;92:1093–102.CrossRefPubMed

39.

Urner M, Limbach LK, Herrmann IK, Müller-Edenborn B, Roth-Z’graggen B, Schlicker A, Reyes L, Booy C, Hasler M, Stark WJ, Beck-Schimmer B. Fluorinated groups mediate the immunomodulatory effects of volatile anesthetics in acute cell injury. Am J Respir Cell Mol Biol. 2011;45:617–24.CrossRefPubMed

40.

Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin. 2008;26:241–72.CrossRefPubMed

Title: Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection
Authors: Yusuke Sugasawa
Keisuke Yamaguchi
Seiichiro Kumakura
Taisuke Murakami
Kenji Suzuki
Isao Nagaoka
Eiichi Inada
Publication date: 01-02-2012
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 1/2012
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-011-1244-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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