Clinical Practice
Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation

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Background

One-lung ventilation (OLV) induces a pro-inflammatory response including cytokine release and leucocyte recruitment in the ventilated lung. Whether volatile or i.v. anaesthetics differentially modulate the alveolar inflammatory response to OLV is unclear.

Methods

Thirty patients, ASA II or III, undergoing open thoracic surgery were randomized to receive either propofol 4 mg kg−1 h−1 (n = 15) or 1 MAC desflurane in air (n = 15) during thoracic surgery. Analgesia was provided by i.v. infusion of remifentanil (0.25 μg kg−1 min−1) in both groups. The patients were mechanically ventilated according to a standard protocol during two-lung ventilation and OLV. Fibre optic bronchoalveolar lavage (BAL) of the ventilated lung was performed before and after OLV and 2 h postoperatively. Alveolar cells, protein, tumour necrosis factor α (TNFα), interleukin (IL)-8, soluble intercellular adhesion molecule-1 (sICAM), IL10, and polymorphonuclear (PMN) elastase were determined in the BAL fluid. Data were analysed by parametric or non-parametric tests, as indicated.

Results

In both groups, an increase in pro-inflammatory markers was found after OLV and 2 h postoperatively; however, the fraction of alveolar granulocytes (median 63.7 vs 31.1%, P < 0.05) was significantly higher in the propofol group compared with the desflurane group. The time courses of alveolar elastase, IL-8, and IL-10 differed between groups, and alveolar TNFα (7.4 vs 3.1 pg ml−1, P < 0.05) and sICAM-1 (52.3 vs 26.3 ng ml−1, P < 0.05) were significantly higher in the propofol group.

Conclusions

These data indicate that pro-inflammatory reactions during OLV were influenced by the type of general anaesthesia. Different patterns of alveolar cytokines may be a result of increased granulocyte recruitment during propofol anaesthesia.

Keywords

anaesthetics i.v., propofol
anaesthetics volatile, desflurane
immune response
surgery, thoracic
ventilation, one-lung
ventilator induced lung injury

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Declaration of interest. The work was supported in part by Baxter Ltd, Germany and by institutional sources.