Objectives: To determine the local and systemic immune response (IR) to open
chest surgery using one-lung ventilation (OLV) during either propofol intravenous
or sevoflurane inhalational anesthesia.
Patients & Methods: The study included 56 patients undergoing thoracotomy and
resection for lung cancer; patients were divided into two equal groups: Group P
received propofol infusion and Group S received sevoflurane inhalation with OLV
using 100% oxygen and a tidal volume of 8-10 ml/kg at a rate to maintain the
PaCO2 between 35 and 40 mmHg. Bilateral broncho-alveolar lavage (BAL) was
performed in all patients in supine position after intubation and at end of surgery.
Synchronously, venous blood sample was obtained and then serum was separated.
The BAL fluid of both sides and serum samples were ELISA assayed for estimation
of interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF)-α levels.
Results: Propofol anesthesia allowed significantly lower blood pressure measures
and heart rate both during two-lung and one-lung ventilation compared to
sevoflurane anesthesia. At the end of surgery, serum and BAL fluid levels of proand
anti-inflammatory cytokines were significantly higher compared to levels
estimated prior to surgery and irrespective of anesthetic modality used. Local
IR was more fulminate than the systemic IR manifested as significantly higher
BAL levels of cytokines estimated at the end of surgery compared to serum levels.
Sevoflurane significantly modulated the local pulmonary IR as manifested by
significantly lower BAL levels of TNF-α, IL-1β and IL-6 with significantly higher
levels of IL-10 in both lungs at the end of surgery compared to propofol group.
Conclusion: Open chest surgery using OLV triggers vigorous inflammatory
response in both ventilated and collapsed lungs. This response was manifested
at the end of surgery and was more pronounced locally than systemically.
Sevoflurane inhalational anesthesia significantly suppressed such local immune
response compared to propofol and is advocated for anesthesia for chest surgery. |
